A Vision for Drug Discovery and Development: Novel Targets and Multilateral Partnerships

Paradigm strain exists in psychiatric pharmacology. The prevailing monoamine-based psychotropic agents have in some circumstances saved lives, robustly benefitted patient reported outcomes (e.g., quality of life measures, functionality), and have facilitated reintegration and recovery. Unfortunately, these foregoing desirable outcomes are an uncommon occurrence for most individuals who receive existing treatments. For the common and severe brain disorders (e.g., mood, anxiety, and psychotic disorders), the insufficiency of extant treatments has provided the impetus to evaluate the role of other targets/systems. Moreover, there is consensus that available psychotropic agents are not ''disease-modifing'' and are rather symptom suppressing an/or providing only for temporary adaptation. The paradigm strain of the monoamine hypotheses has resulted in a large number of antidepressants and antipsychotics that are not genuinely novel when compared to some of the erstwhile psychotropics (e.g., tricyclic antidepressants). It is however, incorrect to conclude that all antidepressants and antipsychotics are identical (they clearly are not), as evidenced by their tolerability, efficacy, and pharmacological profile. The business model in CNS therapeutics has fostered a level of complacency in drug discovery wherein, until recently, the return on investment has justified a maintenance of status quo. The genericization of most psychotropic medicine, the ''patent cliff'' experienced by many blockbuster psychiatric medicines, and the lack of reimbursement by public/private payers has contributed to a lack of enthusiasm for drug development for psychiatric disorders. This foregoing confluence of factors could, however, provide the impetus for a different approach to drug discovery and development. Going forward, psychiatry, and its granting agencies, could do a much better job at instantiating viable clinical targets for psychiatric syndromes. Moreover, multilateral partnerships in other therapeutic areas