via NIMH Director's Blog:
By Thomas Insel on June 12, 2012
an couple excerpts:
"Existing antidepressants and antipsychotics have many proposed molecular targets, but none that have been shown to be necessary or sufficient for their clinical effects.
Amazingly, after three decades of broad use of these medications, we still don’t know how they work when they are effective.
Psychopharmacology is, and always has been "experimental medicine." It is not Evidence-Based. Now, the director of NIMH is stating, "antidepressant effects have variously been proposed to involve changes in serotonin neurotransmission, hippocampal cell birth, and changes in stress hormones, among many other effects. By ruling out some targets and focusing on those involved in the biology of the disorder, we can direct treatment development much more efficiently."
What is Thomas Insel smoking? A pathophysiological disease process causing depression has not been identified. Belief that depression is caused by an unidentified biological disease, is not 'evidence' validating a hypothesis. Without identifying a disease and it's pathophysiology; how could anyone hope to identify a treatment target? Let me guess: the target will be identified after a drug's mechanism of action is identified.
This strategy never has worked out very well.
What 1 Boring Old Man had to say about Thomas Insel and this blog post, New Directions:
He believes what he thinks is the truth. At Yerkes, he was not reappointed Director after five years – largely because the staff didn’t want him back. He was toodirective. He took the term Director literally and tried to channel the direction there too vigorously. Now he’s doing the same thing at the NIMH. I gather he genuinely believes that the future direction for mental health is in newer, more effective medications. Under his direction, he’s incentivised this goal and micromanaged the direction of research efforts.
The argument he makes in this blog could’ve been made at any point in the history of psychiatry, but he presents it with a messianic sense of urgency and priority. His job at the National Institute of Mental Health is to create an environment that shepherds our best and brightest minds to follow their scientific instincts, not Tom Insel’s. Like his colleagues on the APA’s DSM-5 Task Force, he’s trying to hold on to a paradigm that is in a phase of exhaustion, now bordering on toxic. It’s a time for consolidation, for reflection, for stepping back and contemplating. It’s a time for new directions, and a new Director at the National Institute of Mental Health… here