Earth to the Pharmaceutical Industry: Is Anyone Listening?

John McManamy Health Guide
  • One of the benefits of writing about my illness is that I get to bounce ideas off of very smart people. A few weeks ago, at a function in the WashingtonDC area, I encountered a well-dressed man fairly brimming with smart. When I found out he was a psychopharmacology expert working for a major drug company, I immediately forgot about my finger food and assumed my “bounce” mode.


    Here’s what has been playing around in my mind the past few weeks:


    There are no “smart” dopamine meds. The ones we have are “dumb.” Dopamine is a neurotransmitter that plays a key role in pleasure and reward, as well as being involved in motivation and cognition. Too much dopamine in the brain can result in psychosis, manic behavior, and poor decision-making. Too little can result in dulled thinking, no sex drive, lack of motivation, no pleasure, and spastic muscular movement.

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    Here’s the catch: Researchers have mapped out five dopamine systems in the brain. As luck would have it, many of us may have too much dopamine in one brain system and not enough dopamine in the other.


    And here’s the punch line: The meds we have are too stupid to figure this out.


    First example: Amphetamines. These enhance dopamine. By cranking up energy levels, in some cases they may work on one’s depression better than an antidepressant. But because amphetamines are dumb dopamine meds, they may also ratchet up manic behavior and cause psychosis, plus result in no end of problems involving addiction.


    Second example: Antipsychotics. These work by blocking out dopamine. These are your drugs of choice for knocking out psychosis and are a first option for treating mania. But antipsychotics happen to be as intellectually-challenged as amphetamines. Knocking out psychosis tends to come at the expense of taking out one’s sex drive, as well, not to mention causing significant collateral damage in the pleasure and reward and motivation departments.


    Who wants to live like that? Granted, for a lot of individuals antipsychotics are life-savers, but let’s take the argument a bit further. Psychiatrists have identified three domains to schizophrenia: psychosis (what they call “positive” symptoms), impaired thinking, and flat affect (the latter two are referred together as “negative” symptoms).


    By now, you see where this is going. An antipsychotic tends to clear up the psychosis while the rest of the schizophrenia gets worse. No wonder the illness has such a poor prognosis.


    Bipolar is not schizophrenia, but there are a number of parallels. We can get psychotic. At the same time, our thinking may slow down, we may experience no joy, and we may not be motivated enough to get out of bed.


    Don’t get me wrong, in a psychiatric emergency involving psychosis or mania or both, an antipsychotic is probably the best med to get you out of danger. Some of us with persistent psychosis or certain types of mania may have no choice but to stay on an antipsychotic, but unless all your dopamine systems happen to be in overdrive at the same time – Houston, we’re going to have a problem.


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    So what would a “smart” dopamine med look like? I’m no pharmacology expert, but an amphetamine with brakes and gears might be helpful. So would a med that targets one of the enzymes that breaks down dopamine (such as MAOI or COMT), in essence regulating the regulator. A more sophisticated regulator might work on a protein inside the neuron (such as DARPP-32).


    Anyway, here I was, at a function, talking to a drug company pharmacology expert. Maybe he could enlighten me. I began with my “15-second elevator pitch.” It was his turn to talk. He responded by telling me what a great antipsychotic his company had on the market, essentially the same spiel he gives to doctors.


    Uh, perhaps he misunderstood. An antipsychotic is a dumb dopamine med, I explained (but using language far more polite). Patients need smart dopamine meds.


    Again, he started pitching his stupid antipsychotic.


    Wasn’t this guy listening? I thought.


    Then it occurred to me: He isn’t listening! He pitched his antipsycotic yet a third time. There was no point in pursuing the conversation. This guy was nothing more than an over-educated shill pimping his company’s product, incapable of carrying on an intelligent conversation. Why did I think he was so smart?


    A couple of weeks later, back home, one of my email buddies explained it to me: “Drug companies must be one of the few manufacturers in America who are DISinterested in what consumers think of their products,” she wrote. “How crazy is that?”


    Of course, I realized, she is so right. Drug companies are not at all interested in our views. We’re just the dumb patients. We’re supposed to do what our doctors tell us and keep our mouths shut. This is an argument I will advance in future blogs.


    The person who enlightened me is neither a meds expert nor an employee of a drug company. Bipolar runs in her family. At last, I was talking to someone smart.


Published On: April 25, 2007