Psych drug research is stuck. Here’s how to unstick it
BEFORE HE ALLEGEDLY used a kitchen knife to slash Deane Kenny Stryker to death at the Winchester Library, Jeffrey Yao racked up a long record of terror. Neighbors reported property damage and violent behavior, and police took him to Winchester Hospital five times between 2013 and 2017, according to the Globe.
And if it weren’t already clear that the criminal justice system was ill-equipped to handle him, consider this: Yao, who pleaded not guilty, has recently been moved to a maximum security psychiatric hospital, after the Middlesex Sheriff’s Office told a judge he was too mentally ill for prison.
Much about the 23-year-old suspect’s motives is still shrouded in mystery. But Yao’s chaotic journey is a case study on the disheartening lag in new treatment options for those with mental disorders. The fact that this isn’t a new problem doesn’t make it any less urgent. In 2016, the Globe’s Spotlight Team investigated the overall impact of the state’s decision to close psychiatric hospitals without building a sturdy system to replace them. The series found that budget-cutting and retrenchment have left patients at the greatest risk of harming others or themselves in the care of parents, cops, prison guards, judges, and emergency room personnel.
That series focused on a case that has similar echoes and points to the wheel of despair faced by families and professionals alike. A 35-year-old Uxbridge man named Lee Chiero cycled through psychotic episodes and hospitalizations. Chiero would leave with a bottle of medication, but his underlying paranoia made it unlikely he’d swallow many pills, so the delusions would return and the wheel would turn again. In the grips of his illness, Chiero stabbed his mother to death.
Of course, most people struggling with mental illness are not violent. But finding proper custodial care is only part of the puzzle. For lack of a better term, drug development in the field of psychiatry is stuck — robbing patients and therapists of the precision tools needed to treat illnesses that can devastate lives. Although then-new drugs like Prozac helped unlock treatment of depression in the late 1980s, the next wave of blockbusters simply hasn’t materialized.
And existing drugs still come with debilitating side effects. A scenario that played out recently for one elderly dementia patient at a nationally known nursing home chain summoned up the absurd image of a circular firing squad. The nonagenarian patient was given the antipsychotic Seroquel to quiet her anxious shrieks — but the Food and Drug Administration’s guide lists the number one side effect as “risk of death in the elderly with dementia.”
Yet there were few other options. Because it’s difficult — and expensive — to test psychiatric drugs and bring them to market, many pharmaceutical firms have pulled back.
What’s holding research back? “The human brain is extremely complicated. But it’s also invioable. We can’t get tissues in life — and symptoms don’t come from one spot or one cell type, they come from widely distributed circuits,” observes Dr. Steven E. Hyman, director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard and a professor of stem cell and regenerative biology at Harvard University. But Hyman and others are optimistic that new insights emerging from genetic research and from the federal BRAIN Initiative could eventually crack open the field. “It’s early days,” Hyman said, “and we shouldn’t oversell it, but we have the first real molecular information about what goes wrong in the brain to cause schizophrenia.” Scientists are growing three-dimensional “brainlets” made out of stem cells in order to test potential new drugs without using human subjects.
Funding for the federal BRAIN Initiative, launched in 2013 by President Obama, is another unexpected bright spot. The National Institutes of Health budget was boosted by nearly 9 percent in the 2018 omnibus spending bill released March 21, and the BRAIN initiative budget totaled $400 million. Another scourge, Alzheimer’s disease, received $414 million in new funding, a 30 percent increase.
Unfortunately, none of these drugs arrived in time to help Jeffrey Yao or save Deane Kenny Stryker. But the Republican-controlled Congress should keep the funding spigot open, and in this case should be commended for recognizing that basic mental health research must be nurtured now in order to produce payoffs in the clinic later.