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How Close Are We to Cures?

A good question

We recently received the following email:

hi there,

i was wondering how close we are to cures for mental illnesses like ocd, depression and schizophrenia.

I wish there were a simple answer to this question – something like “Really close!” or “We’ll have cures next year.”

But the truth is more complex, and probably comes in several parts.

We are closer to cures than we were before

In part one of the answer, we could compare our search for cures to where we were in 1887, when Emil Kraepelin identified schizophrenia and bipolar disorder as separate and distinct disorders (though he gave them different names than the ones we use today), and in a sense founded the modern study of mental illnesses. Kraepelin believed that there was a biological brain basis to mental illnesses, though he couldn’t possibly know what it was, given that the field of neuroscience had yet to be born.

The answer to our reader’s question in this context is that we are a lot closer to cures than we were then. And however inadequate our current treatments for mental illness are for many people, they are better than what was available in 1887, or even in 1957, when the first drugs for depression, bipolar disorder, and schizophrenia had just been discovered, replacing sedatives, insulin shock therapy, and lobotomy (among other unfortunate treatments).

We are not nearly as close as we’d like to be

White Matter Connections Obtained with MRI Tractography (human brain)

A diagram of connections in the white matter of the brain, captured with MRI tractography.

Part two of the answer is that mental illnesses are really, really complicated. We have about 86 billion neurons in our brains, and trillions of connections between these neurons, and understanding how all of that produces human behavior, emotions, thoughts, etc., is a tall order.

There are people who feel that mental illnesses are not based in brain biology, but OCD, depression, schizophrenia and all the other things we call “mental illness” involve our thoughts and feelings, which originate in the brain. It’s hard to see how we can understand mental illnesses, let alone cure them, if we don’t understand our brains better.

We do know a lot about how the brain works at this point, which means we know enough to realize how much more there is to learn. That doesn’t mean we won’t find improved treatments in the very near future (better medications, better psychotherapy techniques, different ways of affecting the brain like brain stimulation), but it does mean we’re still a long way from actual “cures” for mental illnesses. We’ve made much less progress in mental illness than in cancer, for example. Understanding cancer’s mechanisms has led to effective treatments for many cancers that were almost always fatal only decades ago, even though we might not be able to say we have complete cures for cancer. AIDS is another good reference point—we haven’t cured it, but the current treatments have moved it from a death sentence to a chronic manageable disease for most.

We may be closer than we think

Part three of the answer is that what we’re learning about the brain and mental illnesses is increasing faster and faster. Better technologies for studying the brain and the genetics of illnesses mean we can make discoveries that weren’t even possible a couple of years ago. A good example of this is gene sequencing technologies, which have made it possible to identify genetic variations—some rare, some common—associated with a disease or disorder, and have made it clear that mental illnesses have many genetic factors.

Animation of a neuron being activiated by light.

Optogenetics is a technique enabling neurons to be activated by light.

Another exciting new technology is optogenetics, which allows researchers to turn neurons on and off using light. This is a precise and detailed way of identifying what sort of activity in neural circuits produce behaviors, thoughts, and emotions. And there is an even newer method that scientists are excited about called DREADDs (a catchy moniker for Designer Receptors Exclusively Activated by Designer Drugs), which not only allow scientists to turn neural circuits on and off in experiments, but might even be used as medicines in the future.

And then there’s always luck

Finally, we couldn’t talk about progress in treating human afflictions without mentioning serendipity. Many of the most important discoveries in science in medicine happen by chance. This is especially true in the treatment of mental illnesses, for which many treatments started life with other purposes, or were found completely by chance. But chance, or if you prefer a fancier word, serendipity, doesn’t happen in a vacuum. The scientists who discovered the first antidepressant, anti-anxiety, or antipsychotic treatments were actively doing biomedical research already. That’s one reason that there needs to be a high degree of latitude for researchers to try out new ideas.

This is a long answer to a short but important question. We don’t know how close we are to cures for mental illnesses, but our progress in recent years suggests that we can hold out hope for vastly better treatments leading to fuller recoveries for more people before too many more years have passed. That’s pretty close to a cure!

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