Editorial pubs.acs.org/chemneuro
A Call to Action on Mental Illness from the World Health Organization “When it comes to mental health, all countries are developing countries.” The 2016 Society for Neuroscience meeting in San Diego, CA, was launched with the opening lecture by Dr. Shekhar Saxena, M.D., Director of the Department of Mental Health and Substance Abuse at the World Health Organization (WHO). Throughout the talk, it was made clear that tackling mental disorders on a global scale requires solutions at the intersection of medicine, science, and policy, as well as a profound societal shift on how mental illness is seen, discussed, and managed. Current estimates indicate that approximately 10% of the world’s population is affected by some kind of mental health disorder, including depression, anxiety, and schizophrenia.1 Drug and alcohol abuse, so frequently comorbid with mental illness, are also included in this statistic. Moreover, this number has been steadily increasing over the years; war, natural disaster, economic crises, and forced migration all contribute to declining mental health among a global population. The costs of unchecked mental illnessboth economic and humanare enormous. Untreated depression and anxiety cost the global economy more than $1 trillion in lost productivity each year alone.2 By 2030, the total costs associated with mental disorders could reach $6 trillion.1 More significantly, suicide is one of the leading causes of death worldwide, claiming more lives each year than either breast cancer or malaria.3 But mental illnesses such as depressive disorder, bipolar disorder, and schizophrenia can claim life in more subtle ways as well: “People don’t think these diseases kill,” says Dr. Saxena. “They do.” These disorders are risk factors for other potentially lethal diseases such as HIV, cardiovascular disease, diabetes, and unintentional injury.1 However, patients with mental illness are treated quite differently by society than those with other types of illnesses. In addition, patient compliance to medications is poor, due to issues associated with weight gain, sexual dysfunction, and cognitive dysfunction. Even wealthy nations find themselves underequipped to deal with this health crisis, frequently lacking the policies, funding, and infrastructure needed to reverse current trends. Even as funding agencies aim to commit more resources toward mental health solutions, arriving at new treatment options is a difficult process. Too often, claims Dr. Saxena, the research and medical communities operate in parallel, and rarely intersect or collaborate. This divergence needs to change. From a scientific research perspective, a major challenge to treating mental disorders such as schizophrenia or depression is the difficulty in designing new classes of effective drugs. Since the breakthrough discoveries of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in the 1980s, no new class of drugs for the treatment of depressive disorders has been successfully implemented. We face similar predicaments for treatment of bipolar disorder and schizophrenia. To this point, clozapine remains the most effective drug for treatment resistant schizophrenia, which was developed in the 1960s, and has © 2016 American Chemical Society
serious side effects!4 Recently approved therapeutics can be more effective for certain individuals, or mitigate side effects, but the fundamental biological targets and pharmacological mechanisms of action remain the same. The development of new classes of drugs for the treatment of psychological disorders has been challenging in part because our understanding of the brain, and all of its complex chemistries, is still limited despite vast research efforts in neuroscience. The cost and risk (failure rates) associated with CNS drugs are high, and there has been a mass exodus of big pharma companies from CNS drug discovery recently, to instead focus on oncology (viewed as safer bets).5 To identify new drug targets for the development of novel, more effective therapies, it is essential to further comprehend the underlying biology of these brain disorders. It is critical, then, that increased collaboration and communication occurs among neurobiologists, medicinal chemists, physicians, and the pharmaceutical industry (if they can be lured back). Dr. Saxena recalls the massive funding and research efforts committed over the years toward studying HIV/AIDS and cancer, which have resulted in incredible advances in prevention, diagnostics, and therapeutics for these illnesses. Similar support is needed for making strides in treating the ailing brain. Perhaps a CNS consortium of industry, academia and NIMH is needed, to focus under an agreement of open disclosure to remedy the major unmet medical needs in mental health? To combat the global mental health crisis, the WHO has put out a call to action mobilizing financial, legislative, and societal support worldwide. So, too, must the scientific community take action, in the form of increased collaboration networks among the academic, clinical, and industrial research communities, as well as strong commitments from funding agencies to aid in the development of new treatments and understanding of neuropsychiatric brain disorders. We can get in front of this looming crisis, or we can sit back and witness more tragedies in our communities.
Alyson Weidmann, Managing Editor Craig W. Lindsley, Editor-in-Chief
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AUTHOR INFORMATION
ORCID
Alyson Weidmann: 0000-0003-3876-2847 Craig W. Lindsley: 0000-0003-0168-1445 Notes
Views expressed in this editorial are those of the authors and not necessarily the views of the ACS.
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REFERENCES
(1) Marquez, P. V., and Saxena, S. (2016) Making mental health a global priority. Cerebrum, August http://dana.org/Cerebrum/2016/ Making_Mental_Health_a_Global_Priority/.
Published: December 21, 2016 1620
DOI: 10.1021/acschemneuro.6b00418 ACS Chem. Neurosci. 2016, 7, 1620−1621
ACS Chemical Neuroscience
Editorial
(2) Kleinman, A., Estrin, G. E., Usmani, S., Chisholm, D., Marquez, P. M., Evans, T. G., and Saxena, S. (2016) Time for mental health to come out of the shadows. Lancet 387, 2274−2275. (3) Lozano, R., et al. (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2095−2128. (4) Wenthur, C. J., and Lindsley, C. W. (2013) Classics in Chemical Neuroscience: Clozapine. ACS Chem. Neurosci. 4, 1018−1025. (5) Lindsley, C. W. (2014) New statistics on the cost of new drug development and the trouble with CNS drugs. ACS Chem. Neurosci. 5, 1142.
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DOI: 10.1021/acschemneuro.6b00418 ACS Chem. Neurosci. 2016, 7, 1620−1621
