Psychiatric Times has posted a piece by Arline Kaplan, “NIMH Shifts Focus to Molecular Origins of Mental Illness,” discussing the National Institute of Mental Health (NIMH) decision to begin centering its efforts around preclinical drug development and early-phase clinical pharmacology,. As director of the NIMH Thomas Insel puts it:
For existing treatments, we want to shift from trials studying group differences or adapting these treatments to yet another sub-population to support trials that identify reliable predictors (eg, biomarkers) of individual response, including who may benefit from and who may experience adverse effects of a particular treatment. We are also searching for preemptive treatments—interventions that can be used early in the course of a disorder to prevent disability.
The change in direction was prompted by an August 2010 National Mental Health Advisory Council’s Interventions Workgroup report. The workgroup, Kaplan points out, made a number of observations that have informed the NIMH’s decision, including:
that mental illnesses are brain disorders and that virtually all of them are developmental disorders; that nearly all drugs approved for mental illness have been incremental changes of compounds available 4 decades ago; that the NIMH’s practical trials, such as Clinical Antipsychotic Trials of Interventions Effectiveness (CATIE), have documented the limited effectiveness of current medications; that the NIMH receives relatively few applications proposing to translate basic findings into the development of novel interventions; and that several major pharmaceutical companies have announced plans to “deprioritize” psychiatric drug development.