No New Prozacs: A Dry Pipeline for New Psychiatric Drugs

In 1988, the introduction of  Prozac was hailed as a breakthrough in the treatment of depression. A quarter of a century later, the prospect of a similar breakthrough in psychiatric medications seems remote. On August 19, 2013, the New York Times ran an article called, “A Dry Pipeline for Psychiatric Drugs“.

In the article, author Richard Friedman, M.D. reports that “even though 25% of Americans suffer from a diagnosable mental illness in any year, there are few signs of innovation from the major drug makers.” Friedman goes on to say that “after a series of failed clinical trials in which novel antidepressants and antipsychotics did little or no better than placebos, the drug companies seem to have concluded that developing new psychiatric drugs is too risky and too expensive.”

The reason for this impasse is that the brain is extremely complex and therefore difficult to study.  Knowing how a medication works in the brain does not reveal the cause of the psychiatric disorder it is treating. As a result drug companies are turning their attention to illnesses like cancer, heart disease and diabetes which have well-defined biological markers and are easier to study than mental health disorders.

When I sent this article to a psychiatrist friend he said that he found the article depressing. On the one hand, I understand his concern that the pharmaceutical industry is stymied when it comes to creating a truly novel psychiatric medication. On the other hand, this reality makes it all the more apparent to us to use the effective cognitive, behavioral and spiritual tools that I and others have written about on this blog.

I can speak to this matter personally. I recently had a “mini-relapse” into the anxious state that I experienced in the fall of 1996. The current episode was brought about by a series of Job-like calamities that occurred over summer, Finally, the accumulated stress reached a tipping point, which caused something in my nervous system “to snap” and brought about a biochemical state of hyper-arousal and hyper-sensitivity. I felt as if I no longer had an “outer skin.” Every environmental stimulus was magnified a thousand fold. I felt fragile, vulnerable and fragmented. New situations became threatening. Simply leaving the house seemed like a big deal.

After a few days of being in this state,I decided to call a good friend who also suffers from anxiety. When I explained to him that my symptoms were caused not by catastrophic thinking but by a genuine chemical imbalance, he said, “Well, if the problem is caused by chemicals, then it needs to be treated by chemicals.” (i.e. a benzodiazepine like Xanax or an SSRI antidepressant like Paxil.)  I replied that my previous experiences of taking these drugs had been disastrous. The SSRI’s like Prozac, Zoloft and Paxil had only magnified my agitation, while the Klonopin and Xanax had made me near comatose and nonfunctional.

“Then what will you do?” he asked.

I explained that there are a host of other ways to affect the brain’s neurochemistry, and that I was going to return to these same strategies that I used to cope during my previous episode.

After our conversation ended, I remembered that I had committed to picking up a friend from a doctor’s appointment in 45 minutes. I still had anxiety about leaving the house, so I hopped into my elliptical trainer and worked out for twenty minutes. When I was finished, I felt calmer. The intense exercise had burned off some of the agitating chemicals in my brain.

I was then able to pick up my friend from the hospital. When I returned home, I realized that I needed to eat, having worked up an appetite from working out. I consumed a meal of rice and lentils and added a B-complex vitamin (good for the nerves), which I washed down with a cup of chamomile tea. My rationale for the rice and lentils was that carbohydrates can boost tryptophan transport across the blood-brain barrier, and tryptophan is a precursor for the feel-good neurotransmitter serotonin. Afterwards, I felt calm enough to go back to my writing.

And so I manage this anxiety, one day at a time. I am learning once more that in the absence of medications, there are “low-tech” tools such as diet, exercise, touch, human love and caring, meditation, and spirituality that we can use to improve our mental and emotional state. If indeed there are no breakthrough psychiatric drugs on the horizon, it is even more important that we become familiar with  these tools, place them in our toolbox and apply them as needed.

P.S. After I wrote this post, a reader sent me this link to an article in the New Yorker that elaborates on what the New York Times article said.

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More information about Douglas’s holistic approach to alleviating the symptoms of anxiety and depression can be found at http://www.healingfromdepression.com.