Last night we were honored to have Ildiko Antal, PhD, present on psychiatric medications: how they are discovered and what is known about how they work. Dr. Antal has devoted her career, mostly with Bristol-Myers Squibb, to the development of medications for disorders of the central nervous system.
A challenge in developing psychiatric medications is finding the best candidates for a clinical trial. Compounds that are identified to be promising must be tested in animal studies to gauge effectiveness and toxicity. Physical effects, for example blood pressure, can be directly measured. This is not so for psychological effects. As Dr. Antal put it, “You can’t ask a rat if he is anxious or depressed.” It can take a decade for the rare compound that is approved as a medication to go through the entire process from discovery through clinical trails.
Medications that affect mood are known for their body weight and sexual effects—for good reason. Dr. Antal revealed that all three, mood, appetite and sex drive, follow similar neurological pathways in the brain. This is what makes discovering a safe medication that helps mood without adverse appetite or sexual effects so challenging. With regard to weight, Dr. Antal noted that chewing sugar-free gum has been shown to reduce appetite and, therefore, helps to control weight gain.
Medications must be at a threshold level in the body to be effective. If below that level, they can not work. This is why it is important to take medications as prescribed. Lowering the dose or frequency of taking a medication on your own risks releasing your illness from control.
Dr. Antal views being on medication for a chronic mental disorder as no different than for other lifelong ailments. Many patients with high blood pressure or diabetes accept that they must take medication for the rest of their lives; it is better than the alternative. A mental disorder is a disease of the body no different from others except that the organ system affected happens to be the brain.
Drug interactions are a serious concern. That is why all your prescribing doctors, and your pharmacist, need to know all medications you are taking. For example, caution is required for medications that have conflicting metabolic pathways through the liver as this could lead to unexpectedly high, or low, blood levels for such drugs.
What does the future hold for the development of effective medications with less severe side effects? We need animal models that are better at predicting the effects of potential drugs on humans. And the holy grail is to figure out how ECT, an often effective treatment for persons with drug resistant depression, works so the effect can be mimicked in medication.