Whats the next step in treatment?

[FreudsDaddy]

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It seems like every 20 years there is a major breakthrough or atleast something new to treat mental illness. Could in the next 20 years we see a medication that you take once a month and its at full strength and is a smart drug? Also dont we have some non smart drugs right now you can take monthly? if so what can you tell me about those.

 

[erg923]

Haldol and Prolixin have depot injections, and Risperdal has a long lasting pill (2weeks or so) marketed as Rispedal Consta. Good for people who tend to be noncompliant with meds/treatment or transcient (ie., homless). Seeing that im a psychologist, Im not up on the psychopharm lit on their efficacy...might wanna see what my psychiatric peers say.

 

[fMRI]

- transdermal delivery of standard drugs, e.g. lithium patch etc.
- deep brain stimulation for depression etc., beyond Parkinsons

🙄

 

[OldPsychDoc]

A pill that treats what it's supposed to treat, is non addictive, has no sexual, metabolic, or extra-pyramidal side-effects, and costs less than $5 month...

(...oh yeah, and still comes with a hot marketing rep to bring me lunch once a week and talk about it. 😀)

 

[Doc Samson]

Haldol and Prolixin have depot injections, and Risperdal has a long lasting pill (2weeks or so) marketed as Rispedal Consta. Good for people who tend to be noncompliant with meds/treatment or transcient (ie., homless). Seeing that im a psychologist, Im not up on the psychopharm lit on their efficacy...might wanna see what my psychiatric peers say.

Consta is also an IM not a pill.

Just saw an add this morning for Invega Sustenna which is the invega-version of consta. 🙄

 

[OldPsychDoc]

Consta is also an IM not a pill.

Just saw an add this morning for Invega Sustenna which is the invega-version of consta. 🙄

And here I thought it was a new Japanese car...

 

[fMRI]

... and costs less than $5 month...

(...oh yeah, and still comes with a hot marketing rep to bring me lunch once a week and talk about it. 😀)

Nay, for the $5/month drug, 👍
no food whatsoever and the sweet-talking rep would be ugly.

That's basically how they finance healthcare in Canada and Europe, don't they?

 

[worriedwell]

If I were a betting person, I'd say neuromodulation (TMS, DBS) is the next wave.

I also have an inclination to believe that psychotherapy is going to make a push.

Both of these things in my opinion will happen when more data comes out showing that SSRIs and SNRIs are not a panacea. The patents are all running out so pharma will actually contribute to that as they try to market new drugs, but there will be other forces at play that make this strategy backfire.

DSM V may influence it in some way. So will regulations on pharma influence in academia. Improving evidence base for psychotherapies may be important too.

 

[FreudsDaddy]

If I were a betting person, I'd say neuromodulation (TMS, DBS) is the next wave.

I also have an inclination to believe that psychotherapy is going to make a push.

Both of these things in my opinion will happen when more data comes out showing that SSRIs and SNRIs are not a panacea. The patents are all running out so pharma will actually contribute to that as they try to market new drugs, but there will be other forces at play that make this strategy backfire.

DSM V may influence it in some way. So will regulations on pharma influence in academia. Improving evidence base for psychotherapies may be important too.

Havent tms and dbs already been used? Havent they been around for almost hundreds of years? I figured there would be something like a monthly shot you take that stays fully effective for a month and you have normal moods and feel normal for a month then just take it every month.

Why isnt something like that being developed? Why cant we create a drug like geodon and have it be fully effective for atleast a months time at a time.

I think an advancement would need one of two things. Either no side effects or less pills. Like make a drug that either doesnt have any side effects or make a drug that you have to take like once a month.

Tms and dbs dont seem all that impressive at all.

 

[BabyPsychDoc]

I do not have the references handy, but studies have proven that TMS lacks the efficacy of ECT. While, of course, it could be used for milder cases it is far too expensive to be worth the effort.

DBS is a promising treatment, but there is much to be done in overcoming the stigma of "psychosurgery".

PS. To Freudsdaddy - tms and dbs have been around for less than 50 years, if you count the first primitive attempts . Not "hundreds of years"

 

[kugel]

It seems like every 20 years there is a major breakthrough or atleast something new to treat mental illness. .

Sadly, I think the next truly major, revolutionary development in mental illness will be understanding the genetic underpinnings of schizophrenia and bipolar disorder (and they might be similar or the same), and in utero testing that will give parents the chance to decide if they want to risk bringing a child into the world with a serious chance of developing such disorders.

It's sad, not because of the choice that it would afford parents-to-be, but because we probably won't have anything that will truly change the face and future of mental illness before this type of information is available. This possibility combined with universally available in utero testing for many serious chronic illnesses could actually change the incidence of such tragic disorders.

Remember, studies show that cynical, grumpy, depressed people have a more accurate view of their place in the world - so just because this makes me sad doesn't mean I'm wrong. In fact, it suggests I'm more likely to be right.

 

[FreudsDaddy]

Sadly, I think the next truly major, revolutionary development in mental illness will be understanding the genetic underpinnings of schizophrenia and bipolar disorder (and they might be similar or the same), and in utero testing that will give parents the chance to decide if they want to risk bringing a child into the world with a serious chance of developing such disorders.

It's sad, not because of the choice that it would afford parents-to-be, but because we probably won't have anything that will truly change the face and future of mental illness before this type of information is available. This possibility combined with universally available in utero testing for many serious chronic illnesses could actually change the incidence of such tragic disorders.

Remember, studies show that cynical, grumpy, depressed people have a more accurate view of their place in the world - so just because this makes me sad doesn't mean I'm wrong. In fact, it suggests I'm more likely to be right.

So then are you saying that those who are not depressed are the delusional ones? So cbt is all a delusion and the paranoid/ depressing/ self esteem destroying thoughts are the actual truth and reality of this world? Hard to believe that.

 

[surftheiop]

How far do you all think knowledge could advance before psychiatry and neurology essentially come together?

If over time (decades or more) psychoactive medicines are increasingly well understood/targeted and big advancements are made in psychosurgery then it seems psychotherapy is the only thing psychiatrists would have to offer compared to a neurologist just treating the brain like any other organ is treated. Seems like in the long run (like 50+ years) that neurology could replace all the "medicine" of psychiatry and then psychologists would do the therapy.

That being said, I guess its just as likely that something else seemingly absurd happens, like a "Interventional Psychiatry" field arising where people do a fellowship to learn some form of minimally invasive neurosurgery.

 

[Doc Samson]

How far do you all think knowledge could advance before psychiatry and neurology essentially come together?

If over time (decades or more) psychoactive medicines are increasingly well understood/targeted and big advancements are made in psychosurgery then it seems psychotherapy is the only thing psychiatrists would have to offer compared to a neurologist just treating the brain like any other organ is treated. Seems like in the long run (like 50+ years) that neurology could replace all the "medicine" of psychiatry and then psychologists would do the therapy.

That being said, I guess its just as likely that something else seemingly absurd happens, like a "Interventional Psychiatry" field arising where people do a fellowship to learn some form of minimally invasive neurosurgery.

Neurologists don't want to treat the mentally ill and Psychiatrists don't care about peripheral nerves. There's room for both of us.

Stanford is advertising for an "interventional psychiatrist" in the most recent Psych News.

 

[surftheiop]

Neurologists don't want to treat the mentally ill and Psychiatrists don't care about peripheral nerves. There's room for both of us.

Stanford is advertising for an "interventional psychiatrist" in the most recent Psych News.

What does that mean in today's world? Is it a neurosurgeon who has an interest in psycho-surgery?

I thought I had made up the phrase lol

 

[Doc Samson]

What does that mean in today's world? Is it a neurosurgeon who has an interest in psycho-surgery?

I thought I had made up the phrase lol

A psychiatrist with an interest in DBS, rTMS, VNS, and ECT.

 

[nateshizzle]

The next thing is cognitive bias modification for your iPhone. Cure your social anxiety at least put all those neurotic behaviors at bay. For just 99 cents! Just kidding, its still in clinical trials.

http://www.economist.com/node/18276234?fsrc=nlw|pub|03-09-2011|publishers

 

[surftheiop]

.

 

[surftheiop]

A psychiatrist with an interest in DBS, rTMS, VNS, and ECT.

Ah that makes sense, I'm about to start a bioengineering semester project on brain stimulation, I figured it would be the most related thing to psychiatry I could do in my engineering class. I think the group wants to focus on epilepsy, but maybe I can sway them to the dark side 😉

 

[whopper]

Clozaprexin may be released though who knows when? Its still being developed and may not pass to phase IV testing.

Companies are working on SSRIs that have an added benefit of being a partial agonist of the serotonin 1A receptors (basically as if it's an SSRI with buspirone). Of course an SSRI with buspirone only costs $8 a month, but the newer generation antidepressants that do this function will likely costs hundreds of dollars a month, but doctors that don't know the price of buspirone and the $4 generics (unfortunately plenty of them) and ones that fall prey to anything a drug rep says will give out the expensive stuff. So in short, that pretty much makes it more than half the doctors out there.

A major theory as to why some psychotropics work on some people and not in others has to do with the shape of the medication and how it fits into a specific receptor. The shape of the receptor is based on genetics. With the new technology that allows one's genes to be tested, it is possible that a person, through a gene test, could know which medications would work for them.

E.g. someone is depressed, and now a doctor, instead of having to choose a medication on the mere hope that it will be the one that works will know definitely if it is the best possible choice for the patient based on the gene test.

 

[FreudsDaddy]

Maybe the next step in treatment is no treatment at all or to send the patient to a developing country for full recovery. According to this anyways.

Developing countries:
One of the enduring mysteries in schizophrenia research circles has been the disparity in outcomes between schizophrenia patients in "developing countries" and those in "developed" countries. The mystery arose in 1979 when World Health Organization investigators announced that, in a five-year study, patients in developing countries had fared better than those in the United States and other "developed" countries. A second study then produced the same startling results. In developing countries, the WHO researchers concluded, schizophrenia patients enjoyed "an exceptionally good social outcome," whereas living in a developed country was a "strong predictor" that a person would never fully recover

Short term antipsychotic use:
When Boston University's Courtenay Harding studied the long-term outcomes of 168 chronic schizophrenics discharged from Vermont State Hospital in the 1950s and early 1960s, she found that 34% were recovered 20 years later. This meant they were "asymptomatic and living independently, had close relationships, were employed or otherwise productive citizens, were able to care for themselves, and led full lives in particular." All of the people in this recovered group shared one thing in common: They all had "long since stopped taking medications," Harding told the APA Monitor. It was a "myth," she concluded, that people with schizophrenia "must be on medication all their lives

Link:http://www.psychologytoday.com/blog/mad-in-america/201005/schizophrenia-mystery-solved

Maybe mental illness is nothing like diabetes as once thought.

 

[whopper]

One of the theories as to why there's a better prognosis in developing countries is because in those countries were the studies were done, the family structure is such where families don't give up on their family members and extended family take care of their schizophrenic family members. Compare that to the US where the social drift downwards is more common and family members more often want to have nothing to do with their mentally ill family.

As for the short term study mentioned, notice it was done in the 50s. That was during a day and age where there was a heck of a lot less known than is today.

 

[Gordon Sims]

A pill that treats what it's supposed to treat, is non addictive, has no sexual, metabolic, or extra-pyramidal side-effects, and costs less than $5 month...

(...oh yeah, and still comes with a hot marketing rep to bring me lunch once a week and talk about it. 😀)

Seconded!