America’s mental health crisis: Why we need a Moonshot
Over the last decade, the United States has invested billions of dollars into cutting edge biopharmaceutical research. It’s paid off — we have the mRNA vaccines that helped curb the COVID-19 pandemic; we have new immunotherapies that treat cancers more effectively than ever before; and we have gene editing tools that are redefining how we think about gene function and mutations.
While I’m as thrilled about that progress as anyone else, it starkly contrasts with the lack of progress in mental health — a field that has largely seen a shortfall in innovative treatments for highly prevalent anxiety and depression disorders. Despite urgent patient needs from tens of millions of Americans across all ages and demographics, the number of new mental health medications has largely plateaued since the 1990s. The result is a growing chasm between the amount we suffer and the availability of safe and effective treatment options to ease that suffering.
That simple gap becomes a head scratcher when you think about how far our nation has come in destigmatising conversations around our social and emotional wellbeing. For the first time in our nation’s history, we have leaders like Senator John Fetterman, celebrities like Adele and Selena Gomez, and Olympic athletes like Simone Biles and Michael Phelps talking openly about their mental health. We have a forward-thinking US Surgeon General dedicated to tackling America’s mental health epidemic and emphasising the concerning impacts of social isolation and loneliness and social media, especially among our nation’s youth. And we have new crisis management resources like the 9-8-8 hotline that — while not perfect, and definitely deserving more funding — provides new avenues for Americans to seek real-time help.
Flipping the script
To be sure, we have the knowledge and scientific capabilities to stop a once-in-a-lifetime mental health epidemic in its tracks and to foster a growing awareness and a nationwide cultural consensus that both physical and mental health matter. So, why is our mental health crisis only growing more urgent day-by-day? What can we do to flip the script?
We need a Mental Health Moonshot, and we need it fast. The current world climate and the prioritisation of mental health sets up the launchpad for the moonshot we need, perhaps more so than at any other time in our history. A successful Mental Health Moonshot will require deployment of a three-stage rocket — acceptance, counselling, and medication — all working together towards a successful landing. Without all three, the mission will not succeed.
After decades of widespread use, we know that current drugs on the market for anxiety and depression disorders have real limitations for millions of patients diagnosed with one or both these disorders, which often present as a matched set. It’s time we rethink our approach and focus on developing new safe and effective medications to treat mental health issues in fundamentally different ways.
Using the nose as portal to the brain
Developing faster-acting drugs that do not require “systemic uptake” (i.e., going through the bloodstream) or trigger risk of addiction, for example, could be an innovative pathway for helping patients avoid certain side effects and safety concerns related to current oral medications for anxiety and depression. One of many emerging innovations to help with these challenges is intranasal delivery of neuroactive steroids that do not involve classic abuse liability risks related to dopamine, nicotine, or opiate receptors in the brain. This approach takes advantage of olfactory pathways to the brain, activating fast-acting “nose-to-brain” neural circuits to inhibit anxiety symptoms or relieve depression. Compared to what’s available today, using the nose could offer faster onset and far fewer side effects and safety concerns than SSRIs, SNRIs, and ketamine for depression disorders, and benzodiazepines for anxiety disorders.
With further research and exploration, nasal-based neuroactive drug approaches hold all sorts of promise for different mental health issues. Fast-acting medicines that do not require systemic uptake could be developed for postpartum anxiety and postpartum depression, offering a better safety profile for breastfeeding mothers and those with drug-drug interaction concerns.
For as much progress as we’ve made on mental health care, we still have work to do. Using the nose as a portal to regions of the brain associated with treatment of anxiety and depression disorders is just one of many exciting frontiers for a new generation of much needed neuropsychiatric therapies.
The need for federal and state resources
As we break new ground in biopharma innovation, building a Mental Health Moonshot means building a comprehensive strategy to tackle the underlying causes of people’s anxiety, depression, and suicidality. We need to double down on federal funding for psychiatric research efforts through agencies like the NIH’s National Institute of Mental Health and encourage more private sector investment into innovative companies that are willing to move the ball forward with the development of new mental health medicines with potential to be safe, effective, and faster-acting for conditions like anxiety and depression, both of which are at the centre of the current mental health epidemic.
Also, we urgently need more federal and state resources devoted to training peer-to-peer counsellors and therapists, who play a critical role in ensuring that patients can work with someone who shares their background and understands their experiences – trustworthy peer-to-peer empathy is essential to healing. Financial support for these and other talk therapies — which are core components of treatment for many mental health disorders — will go a long way in expanding access and paving the way for millions suffering from mental health challenges to get the care they need. Finally, we need to find new ways to structure inclusive and accessible clinical trials, so our medicines hold hope for all communities.
As medical breakthroughs happen across other important disease categories, it is essential that leaders in government and industry continue to push for safer and faster-acting alternatives for patients suffering from mental disorders.
For the sake of our loved ones, our communities, and our collective future as a nation, the time for a Mental Health Moonshot is right now.