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Persistent “stigma” and ignorance is holding back the development of new drugs to treat psychiatric conditions such as depression, according to one of the world’s leading brain scientists.
David Nutt, professor of neuropsychopharmacology at Imperial College London, said a dearth of novel treatments meant he would probably prescribe the same type of medicine for a patient today as when he started as a trainee psychiatrist in 1973.
Psychiatric drugs faced far higher hurdles to obtain regulatory approval than cancer medicines, for example, which was deterring both manufacturers and investors from pursuing breakthroughs in the field, he told the Financial Times.
Despite hundreds of billions of dollars being spent on research over the past 70 years, “no major neuro-science-based advances have been made in psychiatric treatments for psychosis, depression or anxiety”, Nutt wrote in the Lancet Psychiatry journal this month.
Contrasting this with the thriving field of cancer research, he said that in the past three years the European Medicines Agency had approved only one new treatment in psychiatry compared with 68 in oncology.
“There is this enormous imbalance in terms of interest, and that must come in part from stigma,” he said.
Part of the problem was a belief by some politicians and policymakers that psychiatric illness was “just kind of suffering the slings and arrows of fortune”, he added.
Former prime minister Sir Tony Blair recently said that “life has its ups and downs . . . and you’ve got to be careful of encouraging people to think they’ve got some sort of condition”.
Nutt suggested such comments risked deterring both manufacturers and investors. “How are you going to invest a billion dollars in a project which might not work, and then be told, ‘Well, you’re not actually going to be licensed because it’s not an illness,” he said.
Equally damaging was a belief that addiction was not a disease but a lifestyle choice, he argued. “We’ve suffered an enormous problem getting any innovation in addiction for those reasons for 15 years and I’m really worried that depression will go the same route,” he added.
The approach taken by global regulators had done little to facilitate the development of new psychiatric drugs, he said. One key obstacle has been their demand that treatments should not be capable of being used in patients outside the strict diagnostic application for which approval had been sought.
Cancer researchers “don’t have to prove [a treatment] doesn’t work in other cancers. They just have to prove it does work in their cancer,” he said, criticising this as a “double standard”.
Psychiatric drug developers are also usually required to judge the medicine against a placebo although no such requirement applies to cancer trials. This “doubles the cost and . . . makes it less likely you’re going to find something”, Nutt argued.
It takes about 13 years and costs $1bn to bring a new brain drug to market in contrast to a cancer drug, which takes around five years and costs $300mn.
Julian Beach, interim executive director of Healthcare Quality and Access at the Medicines and Healthcare products Regulatory Agency, said there were “no differences in the review processes or requirements for psychiatric medicines compared to any other medicines”.
Every clinical trial and medicine submitted to the agency for approval was “rigorously assessed on its own merit based on the benefit and risk balance,” he added.
Nutt called for drug patents on psychiatric drugs to be extended beyond the current 20 years from the date of filing, in recognition of the additional time and costs involved — a move that could incentivise drug manufacturers to pursue research in this field.
“Historically we’ve seen the death of antibiotic research because there wasn’t innovation, there weren’t incentives, and I think we’re going to see the same for mental health research,” he added.
