Why do we only have dumb medications?

[FreudsDaddy]

I would like to get a little discussion going on medications and their intelligence.

I am no expert on medication history and development but id like to hear what others can offer on the subject. Is there any reason medications cant be smart? By smart I mean go to the right parts of the brain only. I believe thats why we have so many side effects because the drug goes to the wrong sections of the brain.


If anyone has a website dedicated to this it would be great. Also is there a name for said drug? I know smart drug isnt the proper name but I havent heard of the exact term for such a drug. Maybe because it hasnt been created yet.

A few questions I have is what development is going on for such a thing? What are some guesses on when this drug could be created and implemented globally?

I know very little about this but i am dying to know more so if anyone has anymore information on this it would be great appreciated. Thank you

---

Members don't see this ad.

 

[Sneezing]

Before you can develop novel targeted therapies, you must first have an exceptional understanding of the disease process - to know where you want to target. We don't understand the pathophysiology of psychiatric illnesses perfectly because the brain isn't as simple as a pump or gastric acid production.

 

[NH14]

It's true that side effects are sometimes due to the low receptor/binding/blocking specificity of certain psychoactive meds. Also, yes, drug researchers are very interested in drugs that are specific in "going to the right places" - especially in formulations that will bind to specific subunits of receptors, which may decrease side effects. But the truth is we really have no idea how drugs will interact with people until those later clinical trial phases, phase III, and then we still learn from adverse event reporting years after the FDA has stamped their approval these meds. Now if only pharmaceutical companies would allow us to see their "proprietary" clinical trial results we may have a better idea of how these drugs operate....but I won't hold my breath

 

[loveoforganic]

There's actually some research that's just getting started in this direction involving bacteriophages. The bacteriophages are cultured, and their capsids are harvested. The capsids can then be functionalized on the inside with drugs and treated on the outside with a polymer to avoid immune response. The non-capsid end of the polymer can be functionalized with a tag that makes it stick to the desired tissue. The problem at the moment is how do you get the medicine out once it arrives at the target tissue, seeing as how they're essentially designed to be as inert as possible. Maybe they can find some enzyme that will specifically cleave the capsids. There haven't been any tests in living organisms yet, as far as I know.

Edit: post above not specific for psychopharm

 

[Scorcher31]

It's good in theory, but at this point in time the specifics of the human mind is probably one of the least understood aspects of medicine. Although there are some "smart" drugs on the market and many more in development, we are probably over a decade away from any smart drug for depression, schizophrenia, etc. At this point we know some meds work, but honestly I don't know how solid the knowledge base is as to why. Are neurotransmitter imbalances truly the cause of depression? What caused the imbalance? Is it serotonin, dopamine, and norepinephrine? Just one or a combination of them? Why does an SSRI work for some people and not others. Is there really just one type of depression or multiple types with differet sources, routes, neurotransmitters, etc? If we don't know the fine details yet, it's very difficult to make a smart drug to treat it.

 

[whopper]

By smart I mean go to the right parts of the brain only.

When someone takes a pill, that medication is diffused through all the parts of the body where the medication can dissolve. Its difficult to make a medication only to go the specific receptor or other site where its supposed to work.

E.g. poor some Kool Aid into a pitcher of water, how are you going to make it only go to a specific part of the pitcher?

It seems you may have come up with an idea that I did in medical school. Why not make a medication that specifically only goes to where its needed? Great idea. How you are going to make it happen? The only way I can think of is by using nanotechnology on an order that's decades ahead of what we can do now. E.g. make a nanotech robot that can swim inside the person's bloodstream and be able to go the specific sites where it can deliver the medication.

One idea a friend of mine had in medical school in regards to psychiatric and neurological meds that need to work in the brain is to put a valve in the back of someone's neck that gave them access to the person's spinal canal. This would allow one to inject medication directly into the cerebralspinal fluid. Yeah well ever think someone who could be stable on medication would elect to have a valve surgically inserted into their spine? What about the risk of infection to the brain and spinal cord? Both would be unacceptable to the vast majority.

I have read of research on some meds to prevent the medication from dissolving into a specific part of the body, but it by no means is specific to the point where it would only bind to the intended receptors. E.g. I saw research on new form of Clozaril (an antipsychotic) where the researchers hoped the medication would have no effect in the human body, but would only have an effect in the brain. It had a molecule attached to the medication taht made the medication inactive and unable to bind to anything in the human body (or at least that's the hope) and when it crossed the blood brain barrier, an enzyme there cleaved off the molecule that inactivated the medication.

I haven't heard anything more about this medication, and for all I know it was rejected by the FDA.

 

[Sust]

While not as elegant as a pill and very much more invasive, Helen Mayberg's work on DBS of subgenual cingulate for treatment resistant depression is certainly eye-catching and thought provoking.

 

[Faebinder]

Right, first the pill needs to get through an acid in the stomach... followed by a base in the small bowel.. get absorbed (so through the columnar cells of the GI) and then in the blood stream penetrate the blood brain barrier. After that you want this molecule that effects "all serotonin" receptors to effect only the ones in the brain, not the ones in the GI, pancreas, fat... etc etc etc.

You need something like Sinimet, that's not easy to do. To make it worse, unlike Parkinson, Depression is not a mostly "one neurotransmittor" deal and neither is schizophrenia or bipolar disorder.

 

[michaelrack]

One idea a friend of mine had in medical school in regards to psychiatric and neurological meds that need to work in the brain is to put a valve in the back of someone's neck that gave them access to the person's spinal canal. This would allow one to inject medication directly into the cerebralspinal fluid. .

Been done (sort of):
http://www.answers.com/topic/ommaya-reservoir#

 

[whopper]

when it crossed the blood brain barrier, an enzyme there cleaved off the molecule that inactivated the medication.

Correcting myself--when it crosses the blood brain barrier, the medication should be activated, not inactivated.

 

[Pneumothorax]

The closest thing in existance to what you're describing of which I am aware are some antibiotics. Impinem and Macrolides (and I think a few others) acheive very high intracytoplasmic concentrations in monocytes. Those monocytes then transport the drug to the site of the infection. That is incredibly brilliant!

Maybe sometime in the future we'll find some molecule expressed at high rates only in certain parts of the brain, and we can use that molecule as a way of targeting a drug. As it stands now, I think we need a better understanding of the underlying disease before we can even begin to think of targeting drugs in this way (but I wouldn't be surprised if this sort of thing happens in our lifetimes!)

 

[Wednesday]

Interestingly one of our dirtiest drugs--clozeril--is one of the most effective.