When I started my psychiatric training it was a time of great ferment. Psychiatry seemed to be at the cutting edge of new discoveries. It was a time of psychedelic drugs, anti-psychiatry, RD Laing, community mental health centres and a cornucopia of new drugs for treating anxiety, depression and psychosis. Psychoanalysis was on its last legs, the biological substrates of psychiatry were becoming predominant, psychosurgery was out, ECT was on the nose, particularly after “One Flew over the Cuckoo’s Nest” (who could forget nurse Ratched).
Since then, sadly, psychiatry has become about as exciting as rehabilitation medicine. It is disheartening to think that psychiatrists are now just part of a team whose only responsibility seems to be medication. All the promise of neurotransmitters has come to nought. We still test new antidepressants for efficacy against nortriptyline, it is like comparing a new Ford against an FX Holden. More and more the focus in psychiatry has become early diagnosis of psychosis but this has also proved to be a chimera. The mental health industry badgers government irresponsibly talking about one in four people having mental illness when the true figure for severe mental illnesses is a prevalence of 3% that has remained unchanged. The one in four referred to people who have troubles, so-called mental health problems leading to a plethora of “helpers”, lifestyle coaches, counsellors, grief counsellors, relationship counsellors, psychologists who do CBT, EMDR and various other acronyms.
I have been dismayed by the role psychologists have played in advising general practitioners about what medication to use. In particular quetiapine 25 mg now routinely prescribed for anxiety.
A recent article in the New Yorker http://www.newyorker.com/magazine/2015/05/18/lighting-the-brain ( I can’t make a direct link, you will need to cut and paste this) has started turning all that pessimism around. The article focuses on the work of Professor Karl Deisseroth, a neuroscientist with a large lab at Stanford who is still a practising psychiatrist. Karl Deisseroth, now 43 has made two amazing discoveries that have the promise to transform psychiatry and allow treatment to become very specific. These two changes include Optogenetics, a technique developed by others that he has refined. “This is a technology that render individual, highly specific brain cells photosensitive and then activates those cells using flashes of light delivered through a fibre optic wire. It gives researchers unprecedented access to the workings of the brain, allowing them not only to observe precise neural circuitry in lab animals but to control behaviour through the direct manipulation of specific cells. The technique allows researchers to trigger activity of cells at the speed that the brain actually works but also to target cells and regions, like the amygdala, where there are mixed populations of hundreds of kinds of cells allowing a previously unthinkable level of experimental precision.”
This has not yet been used on humans but he is already using a variety of other techniques on his patients including vagus nerve stimulation for the treatment of treatment resistant depression with benefit. He only takes on patients who have received no benefit from other treatments. He adapts knowledge gained from his optogenetic experiments to use on patients in his clinical practice. He is currently treating an elderly man with severe depression associated with Parkinson’s disease. He had worked on mice who showed a correlation between depression like states and a dearth of dopamine producing neurones. He had prescribed his patient pills that acts on the dopamine system and it had proven to be very effective.
He has also been instrumental in developing another technology which also has amazing possibilities. He has developed a technique for displacing the fats and water in the brain with hydrogel that allows the brain to become transparent. The director of the NIMH has written a blog about this, go to http://www.nimh.nih.gov/about/director/2013/new-views-into-the-brain.shtml to see a video of this in action.
The New Yorker article goes on to say “increasingly, neuroscientist believe that the key to understanding how the brain works lies in its overall neural circuitry, and the way that widely separated brain regions communicate through the long-range prediction of nerve fibres. In this view, mental disorders resulting from the shorting out or disruption of the largest circuit wiring of the brain-and it is in defining and describing me circuit connections that Karl Deisseroth’s innovations promise to be especially helpful.
I urge you to read this article and like me, it may lift your spirits with regard to our demoralised profession. It does seem that we have a future!
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