Prozac Nation: what lies ahead for mental health treatment?
Mental health treatments have remained largely the same for nearly 30 years. A new push to understand the cognitive science of mental illness is needed to achieve any breakthrough, writes columnist Sam Brown
The Human Connectome Project aims to revolutionise our understanding of the brain, mapping out the infinitely complex neural pathways that facilitate our every thought. A quick look at one of their models shows us the immense progress we are making in the seemingly impossible quest to understand our most intriguing of organs. With this progress comes potential. In particular, for the advance of mental health treatment, with many believing that the future of mental health lies in neuroscience.
This new approach places emphasis on the physicality of the mental, destigmatising and rationalising mental illness by placing it on the same shelf as what we wrongly class as ‘normal’ illness. On the face of it, this approach challenges the current vocabulary of ‘mindfulness’, ‘self-care’, and ‘self-grounding’ with a complex vocabulary steeped in neuroscience and genetics, and champions researching the physical biology of mental health rather than the nuanced psychology of the human mind. In short, brain is being put before mind.
This brain over mind approach is controversial, yet, in my eyes, it is a fruitful step into the right direction. Ever since the days of Elizabeth Wurtzel and Prozac Nation, a mixture of therapy and SSRIs (selective serotonin reuptake inhibitors) like Prozac, Celexa, and Lexapro has been the ‘go-to’ when it comes to conditions such as depression and anxiety. Rather than strive to find the next ‘wonder drug’ like Prozac, however, large pharmaceutical firms have moved away from psychiatric medication because of the high research costs and psychiatry’s decreasing potential for profit. Harry Tracy, whose newsletter NeuroPerspective tracks developments in psychiatric drugs, says that the number of psycho-pharmacological drugs research programmes in larger drug firms has shrunk by 70% in the past decade.
“The government still views mental health as an issue outside of traditional health matters”
There has been some success in this field, however, with much psychiatric-hype focused on an unexpected subject: ketamine. Better known as an animal tranquiliser and sometime recreational drug, Special K has been seen to have dramatic anti-depressant properties and is much more targeted than SSRIs. Richard Friedman, professor of clinical psychiatry at Weill Cornell Medical College, explains further: “Ketamine is interesting because it is the first drug that shows acute antidepressant effects that occur within hours, when currently available antidepressants typically take two to four weeks to work,” he says. “It targets the glutamate system, which is a fast-acting system that no other major antidepressant targets.” Crucially, irregularities in the glutamate system have long been linked to depression.
Other areas of research are equally as ground-breaking and exotic: ecstasy, LSD, and magic mushrooms have all been tested as potentially beneficial additions to psychotherapy. Such advances are revolutionary, yet there is still a stigma surrounding researching drugs that are now embedded in the public’s mind as ‘recreational’. But does the future of mental health treatment lie simply in drug development? Of course not. Indeed, to boil down every complexity and intricacy of mental health to neuro-biology would be an insult to anyone who has suffered the pains of a mental illness. This is where the current government can make a clear and immediate difference with funding increases. While little can be done in the short term to pressure major pharmaceutical firms to invest more in drug research and development, funding to expand CBT (Cognitive Behavioural Therapy) services is entirely within their capabilities.
Despite this potential for improvement, funding is falling in real terms, partly because the government still views mental health as an issue outside of traditional health matters. Marjorie Wallace, chief executive of the mental health charity Sane recently said: “A recent report found that 40 per cent of the mental health trusts in England had seen cuts to their budgets, and figures show mental health trusts received none of the extra £8bn funding for the NHS over the last four years.” Although government may produce the right mental health narrative and dialogue, speech and nothing else is not good enough.
As our knowledge of the brain continually expands over the next few decades, the way we approach mental illness will undoubtedly shift. Alongside this advance in knowledge will come a new scientific vocabulary for discussing conditions such as depression, anxiety, bipolar disorder, and schizophrenia, reducing stigma by removing the artificial barrier between mental illness and so-called ‘physical’ illness. The future of mental health treatment is certainly exciting and pioneering – one can only hope that this future will arrive soon
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