Mental Illnesses, modern medicine has made little progress
After so many years of spectacular progress in many fields, modern medicine has met on the road to mental illness more difficult obstacles than infectious diseases themselves. but yet brain diseases are, according to the OECD, the leading cause of disability in Western countries. They represent between 30% and 40% of the long-term sick leave and cost 4% of GDP. Yet, after decades of research, the dementia caused by Alzheimer’sfor example, it has no effective treatment and, for other psychiatric disorders, such as schizophrenia or depression the therapeutic options are few, of limited efficacy and often with relapses. In the magazine “Frontiers in Psychiatry”in a study of people with severe depression, only 31% found improvement after 14 weeks of treatment with selective serotonin reuptake inhibitors. In bipolar disorder, only 24% got rid of depression for eight consecutive weeks. And in patients with schizophrenia74% found it difficult to continue treatments a year and a half after starting
Mental illness, the difficulty of psychiatrists in caring for patients
Jorge Manzanaresprofessor of pharmacology and lead author of the study, argues that successful psychiatric treatment depends on many factors. such as the severity of the case or the skill of the psychiatrists themselves “Unlike doctors who can measure certain factors related to a disease (such as hypertension or transaminases) and intervene accordingly, psychiatrists move in a very empirical and more traditional way and have no markers of genetic or anatomical alterations or protein markers to help them in their decisions. Their success therefore depends a lot from experience of the psychiatrist in evaluating the patient and choosing a treatment or deciding when it should be changed. ” Now the diagnosis of these disorders is made with an examination of the patient following developed guidelines and tests to identify the different pathologies, but it is not possible, for example, to improve the evaluation through a blood test or an MRI.
Mental illness, few indicators to diagnose or predict the disease
However, this does not mean that biological or anatomical features relating to various disorders have not been highlighted. “If we compare a significant number of people with disorders such as autism, schizophrenia or bipolar problems with a group without disease, we observe evident biological differences, from alterations in the structure or volume of some brain areas to the greater or lesser presence of inflammatory markers-detects diseases Guillermo Lahera, psychiatrist at the Príncipe de Asturias University Hospital-but, at the moment, none of these biomarkers are useful for diagnosing or predicting the onset of the disease. “Biomedical science has offered effective solutions to many evils, but it has been possible to detect how difficult it is to get rid of many others. Most of the diseases are multifactorial and among these, in particular, there are psychiatric ones. According to several mental illness researchers, the factor genetic is very relevant (a person with a schizophrenic father and mother has a 40% chance of suffering from the disease), but the genes involved can be tens or hundreds. Then it must be borne in mind that other external factors, such as prolonged stress, a viral infection or exposure to certain toxic substances, they are enough to start the disease.
Mental Illness, the Future of Research Driven by Advances in Neuroscience, Genetics and Technologies
As for the future, the knowledge of mental disorders will be guided, in the coming years, by the progress of neuroscience, genetics and technology. “The neurobiology of mental disorders is extremely complex – several psychologists agree – because various neurotransmission systems, various neuronal connection networks participate in it and all of this is in something dynamic, in continuous interaction with the environment”. Diseases of the brain can be triggered by contact with a virus or toxic substancebut also from one suffering situation resulting from a personal situation. “Our existence in the world depends on our biology – says Laher – it is not that the mind is the brain, it would be reductionist, but the brain emerges from the mind and, therefore, there is a direct and bidirectional influence between the environment and biology “” Neurobiological research on mental disorders, when rigorous and complex, is not at all opposed to the decisive role of the environment, the importance of subjectivity or psychotherapy. Biology is all this and more “, concludes the scientist.
Mental illness, new biomarkers to help search for new drugs
The discovery of reliable biomarkers of mental illness can help to research new drugs, more effective or with fewer side effects, but would also serve to evaluate their combination with psychological therapy. Biomarkers (real indicators) more important will be those that will allow to predict the likelihood of a type of treatment being successful or that will offer clues to the search for new treatments. As with cancer, within diseases such as schizophrenia, depression or bipolar disorder, there are so many varieties and characteristics that add up to a patient, and current tools for treatment are still scarce. But these indicators could also serve to anticipate the risk of developing the disease.
Mental illnesses, the search for new drugs continues
Despite the limitations, the study of brain disease has produced significant improvements in the lives of patients. Starting in the 1950s, the emergence of the first antipsychotics allowed some people with schizophrenia to get out of asylums and to start leading a relatively normal life. And at the same time, in the middle of the last century, the first effective antidepressants were discovered. Thereafter, progress has been slower, with improvements, primarily, in the safety or ease of subsequent treatments. Recently some substances such as MDMA or psilobicin are showing promising results against post-traumatic stress or depression and in 2019, approval esketamine for the treatment of major depression it has been seen as a change of course towards success. But the truth is that science, while positive, still has a lot to say regarding the area of mental illness, perhaps the most complicated of all that affect mankind.