Technology has revolutionized the field of medicine. It certainly has helped refine the art of making antidepressants and antipsychotics, introduced in the 1950s, but it has not yet led to a new generation of psychotropic medications.
The need is great, given the widespread impact of mental illness. According to the National Institute of Mental Health, one in four adults -- some 57.7 million Americans -- will experience a mental health disorder in any given year. One in 17 Americans lives with a major mental illness such as schizophrenia. An estimated half of U.S. prisoners suffer from mental illness. If we could find drugs or treatments to treat people and their ailments, think how much crime could be prevented.
Even if you're lucky enough to have avoided personal experience with mental illness, you've probably felt its impact. Mental illness may afflict a loved one, a friend or a neighbor. Perhaps you or someone you know was the victim of a crime perpetrated by a mentally ill person. In any event, we all have a stake in the future of this critically important field.
Some people believe psychiatry relies too heavily on medication. Books have been written about the prevalence of over-medicated children and adults. Psychiatrists and journalists argue over whether some people who have been medicated might function better with talk therapy or a holistic approach to treating depression.
Psychiatry has proved that mental illness is the product of biochemical aberrations and that it deserves parity with other fields of medicine. Just as diabetes is a result of the body's inability to produce enough insulin, biochemical depression is caused by an imbalance in serotonin levels. Many forms of depression can be resolved with drugs that step in where nature has failed, alleviating or reversing biochemical abnormalities.
Scores of issues are roiling the field of psychiatry.
First and foremost is the powerful drug lobby -- Big Pharma -- and its seeming control over how and why antidepressants and antipsychotics are widely prescribed. Another is why more of the new drugs have not produced better outcomes for patients than some of the older agents. A tenth of Americans 12 and older take prescription antidepressants, the Centers for Disease Control and Prevention reported in 2011. Meanwhile, meta-analyses show their value is more limited than experts had hoped it would be.
One more contentious dispute is over why doctors increasingly prescribe mood stabilizers and antipsychotic drugs for patients, including children and adolescents, who don't have the bipolar disorder for which these drugs originally were targeted.
Lastly, the use of prescription cocktails is highly controversial; very few drug combinations have been tested in clinical trials. Each drug carries its own set of noxious side effects, including nausea, drowsiness, dizziness and weight gain. Especially with drugs for major mental illness, the side effects become intolerable for patients, who then stop taking them.
The future for this field is limitless. The April issue of Nature describes research on molecular psychiatry, in which a drug company, medical device manufacturer and university think tank are collaborating to find ways to regulate the body's organs and functions through electrical impulses. They're not really drugs at all; they are implantable medical devices that could have a profound effect on regulating mood disorders and many other diseases.
But resources are limited, spurring more debate over how best to use them.
(Bonnie Erbe, host of PBS' "To the Contrary," writes this column for Scripps Howard News Service.)