Ending the Madness

Of all the unmet medical needs confronting the healthcare industry today, psychiatric disorders looms large. For vendors of noninvasive and implanted neuromodulation systems, the market for treatment-resistant depression in particular is both alluring and elusive.

Few people in this country are as aware of the shortcomings of our mental health system as Tom Insel. As the former director of the National Institute of Mental Health, he has seen firsthand the suffering of people with psychiatric disorders who have not received adequate treatment. As a practitioner, government scientist, and digital health industry executive, Insel has endeavored to bring change to the way our society recognizes and cares for individuals with psychiatric disorders. Some of his recommendations have attracted criticism from stakeholders content with the status quo. Speaking at the Neurotech Leaders Forum in 2017, Insel downplayed the role of the Diagnostic and Statistical Manual in diagnosing psychiatric disorders and instead argued for uncovering biological biomarkers for different mental diseases.

Insel’s latest effort to change the framework of mental illness is the publication of his new book, Healing: The Path from Mental Illness to Mental Health (Penguin Press, 2022). In it he argues that our system fails at every stage to deliver adequate care. For example, he takes aim at our focus on drug therapies that reduce symptoms rather than produce long-term recovery. His path to healing relies on the three Ps: people, place, and purpose.

Citing depressing statistics about suicide in the U.S.—the majority of which result from depression and related disorders—he points out that the disease is more lethal than breast cancer, prostate cancer, and AIDS. And people with mental illness who don’t commit suicide are likely to die 23 years sooner than other Americans because of overall inadequate medical care. “People with mental illness are missing out on a century of medical progress that has extended life expectancy for Americans from 55 to nearly 80 years,” Insel writes.

One prominent medical professional who agrees with Insel’s call for more biologically oriented diagnoses and therapies for mental illness is Helen Mayberg, director of the Center for Advanced Circuit Therapeutics at Mt. Sinai in New York City. During her talk at the AAAS Annual Meeting earlier this month [see article, p6], Mayberg identified at least two viable biomarkers that indicate the presence or absence of a depressed state as well as a DBS targeting strategy that produces long-term benefit to patients with treatment-resistant depression.

Further development of therapies such as this will not only lead to commercial success for neuromodulation vendors, it will also offer people with mental illness a level of care on par with those with other diseases.

James Cavuoto
Editor and Publisher