The failures of the past are now driving an exploration of many more fundamental ideas about what could go wrong in the brain
Save time by listening to our audio articles as you multitaskHere patients benefit from a more detailed diagnostic approach than the distinction between mania and torpor. Almost 300 mental-health disorders are recognised by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the authoritative guide on such matters.
To understand how things came to be this way a short journey into the history of drug development is useful. The number of people in hospitals like Bethlem rose relentlessly for centuries. Then, in the 1950s, research into antihistamines by Rhône-Poulenc, a French drug company, produced chlorpromazine, a compound which appeared to cool the body and was judged to have some potential in anaesthesiology.
This marvellous serendipity delivered drugs that worked much better than anything psychiatry had previously had to offer. By doing so it made it possible for conditions that had previously seen people hospitalised to be treated in the community. But it also had a long-term side-effect. The good fortune meant that drugs came about without a clear account of the deficit or problem they were addressing. When luck ran out, there was not enough by way of understanding to replace it.
High failure rates are one of the reasons why, from 2010 on, a lot of pharma firms largely left neuroscience or radically pruned their work in it. They included, AstraZeneca, Bristol-Myers Squibb, Pfizer and Amgen. Other big firms cut back. And if the withdrawal was quite broad, and the reasons multiple, the single most important factor behind this can be traced to the fortunes of those seeking therapies for one disease in particular: Alzheimer’s.
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