Eli Lilly's experimental drug-known as LY2140023-promises to reduce schizophrenic symptoms by acting on glutamate, a key transmitter in the brain that is a critical link in circuits involved in memory, learning and perception. With possibly fewer side effects than Zyprexa, this new drug appeared to improve cognition, something the second generation of atypicals has failed to do.
Eli Lilly is likely to move ahead with a clinical trial involving thousands of patients if the drug's efficacy is proven by early next year. I am unreservedly optimistic about this good news, and I'll tell you why. So far, no schizophrenia drugs-either the traditional neuroleptics or atypicals-have been able to treat one of the symptoms most stubbornly resistant to change: anosognosia, or the lack of insight that one is sick. Up to 50 percent of the people experiencing delusions and hallucinations are not aware they have a medical condition needing treatment.
It's hard for a healthy person with a rational mind to fathom that someone else could genuinely believe the CIA has given him telepathic powers to influence the 2008 election results. When hard, cold evidence to the contrary doesn't support his delusions, you'd think he'd be deterred from continuing his mission. Wrong again. The hat trick of psychiatry-making anosognosia disappear-remains an elusive feat. Such techniques as motivational interviewing and LEAP, discussed in Xavier Amador's book, I Am Not Sick, I Don't Need Help, could be employed in an effort to get a patient to take his meds.
With the advent of the new drug, perhaps, with all due respect to Amador, his book will become obsolete. If clinical trials could prove the Eli Lilly drug improved cognition, I'd feel justified in my expectations for LY2140023. Another limitation of the atypicals: they don't work spectacularly-if at all-on the negative symptoms of schizophrenia, such as lack of volition and motivation. In addition, one person I knew who was prescribed Geodon (a drug I take) felt it clouded her thinking. Though I haven't experienced side effects from this drug, our competing outcomes show that not all sz meds work equally well for everyone. So far, there's no way to predetermine who will respond favorably to a certain medication.
Eli Lilly's breakthrough has already sent its competitors scrounging to find a psychotropic that works on glutamate, and so hopefully this frenzy of research and development will yield other novel agents, not just a glut of "me-too" drugs that all act in the same way.
The worldwide sales of drugs for brain and psychiatric diseases total almost $50 billion annually. Pharmaceutical companies have an ethical responsibility to create alternatives to the current drugs on the market. Even with their benefits, the atypicals don't relieve all symptoms at all times, and that is perhaps a noble goal, short of a vaccine to prevent the schizophrenia in the first place.
