From ketamine to cupboard therapy: the future of mental health treatment

With big pharma short on solutions, we talk to people pioneering new ways to beat conditions including anxiety, depression and schizophrenia

Once upon a time, the future of mental health treatment was drugs. The advent of Prozac and whole class of similar medication in the 1990s gave doctors an easy option and big pharma easy money.

But 20 years on, the problems have not gone away. In fact, mental illness is much more pervasive, with depression now the world’s second biggest cause of disability.

Moreover, a dramatic reduction in drug research and development suggests pills will not be the only – or even the primary – answer to mental health problems in the long term.

But what will be?

The laboratory

One reason Sergiu Pasca, assistant professor at Stanford University, went into research after completing medical training was his frustration when he saw what oncologists could do for their patients and how limited he and his colleagues were in treating mental health problems.

This was partly to do with the difference in funding for cancer and mental health research. But there was also the question of access.

“For cancer you can remove the tumour, and we can grow these cancer cells in a dish. If you find a small molecule that stops uncontrolled proliferation of these cells, you have a potential drug for cancer,” said Pasca. “In contrast with that, we don’t have direct access to brain cells, you can’t do a brain biopsy. Therefore, in studying mental disorders, we look at postmortem brains. That’s a problem for me as a neuroscientist because these neurons can’t fire,” he said.

Pasca’s laboratory has found a way to solve that problem, at least in part. Using stem cell technology, the team takes skin cells from living patients and from those develops a small spherical piece, up to 5mm in diameter, of functioning human cortical brain tissue. These small pieces, and there are thousands sitting in petri dishes in Pasca’s lab, have a structure very similar to the human cerebral cortex, the outer layer of the brain, and have neurons that fire.

Since these cultures have the DNA of whoever they are taken from, Pasca is able to compare brain tissue made from the cells of people with conditions such as autism and schizophrenia in the hope of working out how these conditions develop on a molecular level.

“It’s very likely that, as a community, we’re going to identify the causes, the mechanisms and probably specific therapies for particular forms of psychiatric disorders, pretty much like we’re doing for cancer today,” said Pasca.

The research is expensive and labour intensive, with each piece of brain tissue requiring about 20 weeks of almost daily cell culture work, but he believes it is likely to yield results, particularly for conditions that have a strong genetic component, such as autism, schizophrenia and forms of intellectual disability.

“In the next 10 years I think we’re going to understand more and more psychiatric disorders at the molecular level. I am convinced we’re going to witness a revolution in psychiatry,” he said.

The therapy

Dr Andrea Reinecke, clinical psychologist and researcher at Oxford University, is pioneering a new, and some might say tough, form of cognitive behavioural therapy (CBT). Her one-off sessions involve locking her patient in a cupboard so he or she can have, and get through, a panic attack.

In the first experimental study, which tested the impact of one-hour sessions of CBT on patients with panic disorders, all 30 patients showed improvement and one-third reported being completely free of symptoms a month later.

A second study combining the one-hour CBT with cicloserine, an antibiotic known to have a positive impact on neuro-plasticity, is about to be completed and looks set to report even better results.



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