Symptomatic versus disease‐modifying effects of psychiatric drugs

Abstract

Objective: Drugs can be divided into two major categories, symptomatic and disease modifying. This review explores whether and how psychiatric drugs fall into one or the other of those categories, and the implications of those results for clinical practice and research in psychopharmacology.Method: Narrative review.Results: Most psychiatric drugs have only short-term effects of improving active symptoms. They do not show long-term benefits for the underlying disease, such as improving the course of illness and improving mortality. Evidence is provided for this claim in the treatment literature of antidepressants for depressive illness and antipsychotics for schizophrenia. Developing truly beneficial drugs for disease modification also is limited by the poor clinical and biological validity of Diagnostic and Statistical Manual diagnoses as well as the use of invalid falsely positive maintenance efficacy randomized discontinuation trial designs. Conclusions: Current psychopharmacology is limited mostly to symptomatic effects, not transformative treatments for the diseases underlying those symptoms. A change in approach is needed in psychopharmacology practice and research, focusing on long-term disease modification rather than short-term symptom improvement.

Psicodélicos: ¿disputan el campo terapéutico?

“…5,6 Esta potencial cualidad tal vez pueda ser reconocida como criterio, para ser considerados como medicamentos en psiquiatría; o tal vez nos remita a la cuestión planteada por Nassir Ghaemi, quien sostiene que la mayoría de los fármacos en psiquiatría ejercen un efecto sintomático, pero no son modificadores de la enfermedad. 7 En ese sentido, los psicodélicos podrían actuar directamente sobre el sustrato neurobiológico de la depresión promoviendo procesos de plasticidad tanto estructural como funcional en la corteza prefrontal. Esto explicaría, al menos en parte, los efectos antidepresivos sostenidos durante meses luego de la administración de una o dos dosis del fármaco.…”

Drug Discovery in Psychiatry: Rethinking Conventional Wisdom

“…The concept of disease modification in psychiatry is another topic that requires separate full-length discussion, provided in more detail elsewhere. 8 Briefly, following approaches taken in neurology, 9 it can be suggested that disease modification can be defined partly biologically and partly clinically.…”

The Need for Non-profit Psychiatric Drug Discovery and Development

“…Hence they are a poor example for claims of truly transformative scientific innovation. Some may disagree with these statements, and space precludes full discussion here, but such discussion is provided elsewhere 7 …”

“…Some may disagree with these statements, and space precludes full discussion here, but such discussion is provided elsewhere. 7 These high costs also are reflected in high attrition rates. Around 90% of drugs in early discovery eventually fail in the course of development.…”