LAUSR

It is simple enough to enumerate the shortcomings of existing pharmacotherapies for depression: the desire for drugs with faster onsets, higher remission rates, fewer side effects, robust anti-suicide properties, breadth of spectrum across subtypes (melancholic, atypical, agitated, chronic, bipolar), cognitive benefits, durable relapse prevention and persistence of efficacy, better functional outcomes, and the like; but it is a far more complex and speculative effort to propose viable strategies for their remediation. The latter of these is especially daunting in light of two recent events: (1) NIMH’s 2014 decision no longer to fund intramural or extramural clinical trials for the sake of symptom relief, but only when a drug can serve mainly as a ‘probe to generate information about the mechanisms underlying a disorder’ (https://www.nimh.nih.gov/about/ directors/thomas-insel/blog/2014/a-new-approach-to-clinicaltrials.shtml), and (2) growing divestment within the pharmaceutical industry from research and development of new psychotropic compounds, both in the US and abroad [1]. While the NIMH’s quest for ‘precision medicine’ [2] is scientifically laudable, its decision to prioritize the search for suspected and elusive neurobiological causes of mental illnesses – and to link that search inextricably with efforts to advance therapeutics – will not likely reverse the relative standstill of new drug development in psychiatry, or improve delivery of mental health services to those now in need.