The Canberra Times

by Lesley Russell

The need to do more to address the needs of the mentally ill is always in the news and daily on the minds of those who care for these people, but it seems is never a priority for policymakers and politicians.

Neither is it a priority for the pharmaceutical industry. Medications, alone and in combination with other therapies, have an important role to play in the treatment of mental illness.

So it is disturbing to realise that the medicines available today are not particularly effective, and that there are no innovative new medicines on the horizon.

In 2007, the United States' National Institute of Mental Health completed a series of practical trials to assess the effectiveness of currently available medications. Together these studies, on schizophrenia, depression and bipolar disorder enrolled about 10,000 patients at nearly 200 sites. These trials told researchers what they had already surmised from several worrisome public health indicators: the medications available today, even when optimised within a research study, only help some people get better.

The director of the NIMH, Thomas Insel, summarised it this way: ''If we are honest with ourselves and our patients, we need to admit that today's treatments, both medications and psychosocial interventions, may be good but they are not good enough.''

There have been only two major drug discoveries in the mental illness area in the past century; lithium for the treatment of bipolar disorder in 1949 and Thorazine for the treatment of psychosis in 1950.

Almost every major psychiatric drug introduced since has resulted from small changes to Thorazine, and scientists still do not know how these medicines actually work.

Developing a new generation of medications based on truly novel compounds with far greater efficacy and effectiveness will require an evidence-based approach to therapeutic development.

Last year, a group of distinguished scientists, including three Nobel laureates, published a commentary in the journal Science that outlined how the same approaches that have worked to develop new medicines in cancer and immunology can be applied to develop innovative, effective psychiatric medications.

That means understanding the mechanisms responsible for disease, identifying targets and genes through which these mechanisms can be altered, and building the pipeline to create innovative medications.

Who will develop this new generation of medications for people with mental illness? Traditionally this has been the role of the pharmaceutical industry, building on basic research findings that have been largely government funded.

But this traditional model appears to be in trouble as biotechnology and pharmaceutical companies are moving away from work on the central nervous system, citing the difficulty of creating new drugs in this area.

The director of the US National Institutes of Health, Francis Collins, has pronounced himself ''a little frustrated'' with the pharmaceutical industry's apparent inability to rapidly follow up on scientific breakthroughs in many areas. He is pushing ahead with ambitious plans to create a new centre for translational medicine that will do some of the early-stage work for the drug development industry.

Collins's plan, apparently endorsed by President Barack Obama, is to bring together $700 million in NIH-based work under one roof at a National Centre for Advancing Translational Sciences. The aim is to enlist government scientists and funding to push pharmaceutical projects through the ''Valley of Death'' – the chasm between a promising scientific discovery and a new treatment for patients.

Whether the Government can succeed where private industry has failed is uncertain, officials acknowledge, but they say doing nothing is not an option.

Insel at the NIMH says that the pharmaceutical industry's departure from this vital research area shows that the government must do something, although he acknowledges the risk: ''Would we be foolish – we being an agency that has never developed drugs and actually doesn't know how to do therapeutics that well – to get into this space?'' he asked.

Will Australia also be bold enough to also enter this arena? Compared to the resources of NIH and the pharmaceutical industry, local funding for translational research is small, but this is offset by the quality and international impact of Australian basic research in the relevant areas.

As the Government pulls together the federal budget, support for development of new therapies for mental illness would be a sound investment and signal a commitment to mental health that has been strikingly missing.