Reflections on new/old ideas for treatment

There are many appealing new (and not so new) ideas coming up about treatment of mental illnesses.

Genetic profiling:

So far gene testing can predict likely responses to certain medicines and suggest individualized dose ranges depending on speed on metabolism. Most of the actual human studies so far have been done on antidepressants- those still on patent, of course, and likely to make money for the developers.

Someday it may be possible to test for genes for susceptibility to mental illnesses, autism, increased likelihood of psychotic and other extreme responses to recreational drugs and alcohol. Numerous genes have indeed been identified as occurring more frequently in affected people, but NONE of them are unique to affected people only.

Brain inflammation:

We are finding more noninvasive ways to track what happens in the working brain which has lead to exciting information about neuroplasticity, the glial (lining and insulating) cells and the ill effects of inflammation. The causes of this inflammation in the brain are still unclear. In any part of the body, inflammation can be caused by infection, autoimmune processes, circulatory compromise leading to tissue breakdown, injury, exposure to toxins. Each of these causes leads to different plans for treatment.

The gut biome:

Finally, we are accepting that each of us is a small ecosystem, with symbiotic relationships with about 5 pounds of gut bacteria of different types. The "human" part of this system provides a safe home and a food supply to "them" in return for a steady and balanced supply of micronutrients, antioxidants, and breakdown products which affect both the physical and mental well being of the human component ("us") of the ecosystem.

Another huge conceptual shift that has occurred during my professional career is actually a return to an older, more "organic" way of looking at mental distress. Medicine, including psychiatry, was seduced by the idea of discovering THE cause of any given illness, which of course would then lead to a cure. In every field, from infectious disease to psychiatry, the data have forced physicians to accept that there are hardly any maladies out there, from tuberculosis to schizophrenia, that are not multifactorial in origin, and that don't require "restoration of harmony", not just a pill, to treat. This is not to say that the search for "the silver bullet" doesn't go on, among physicians, researchers, the public, and a variety of entrepreneurs.

It’s a lovely thought, but in my opinion, treatment will remain complicated and multifactorial for a long time.

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