George Carpenter: It’s Time to End Trial and Error Prescriptions for Mental Illnesses

While we don’t yet know whether prescription drugs played a role in the Sandy Hook Elementary shooting, the tragedy in Newtown, Connecticut has rightly forced a new public dialogue on how to confront violence and ensure the safety of our children. Politicians will undoubtedly debate the impact of video games, movies, guns, family values or prayer in public schools on the recent violence. But in the aftermath of this heartbreaking shooting, many are also challenging old assumptions about mental disorders and the drugs that treat them.

There is no denying that today’s mental health care treatments are producing poor results. In fact, only 12.7% of Americans receive “minimally effective” treatment according to government studies. We must do better. We can’t afford to accept treatment failure in mental health any longer. While civic leaders look for solutions, they should also accelerate new technologies that are offering promising answers to help those with mental disorders get the right medications.

Millions of people diagnosed with Depression, ADHD, PTSD or schizophrenia are given drug therapy each year. In fact, medications have become the dominant treatment for mental disorders. In the last two years alone, antidepressants have become the most frequently written prescription in America.

But these medications only work about one-third of the time. Mental health advocates on both sides of the treatment debate are right to be concerned with this growing drug usage. The fact is that we overmedicate some patients but under-medicate others. The common element is that doctors are forced to use trial and error prescribing — a process that is exactly what it sounds like.

Trial and error treatments are not only costly; they can also have serious negative side effects like suicide, agitation and violent behavior. The wrong drug can lead to a devastating outcome. Prescribing medications through trial and error isn’t just a waste of medicine, it’s a waste of time. And time is one thing a lot of these folks don’t have. No individual or family member of a mentally ill patient wants to wait for a drug to work that, based on their individual physiology, has little chance of ever being effective.

For returning Iraq and Afghanistan veterans experiencing depression and PTSD, this is an emerging health crisis playing out in real-time. Over 1 million US troops have fought in wars since September 11, 2001 and estimates are that over 30% will return with some sort of mental health issue. Unfortunately, these numbers keep growing. As former Senator Max Cleland says, “there are NO unwounded warriors”.

Historically, there has been no physiological test to guide mental health professionals on which medication will work best. There is no x-ray, no blood test or even a CT scan for mental illness. Without an objective measure, physicians are left to try different therapies and wait to see how the patient responds.

Secretary of Defense Leon Panetta has solved countless difficult problems in his years of public service, but he calls the problem of mental health treatment one of the most frustrating of his career. Military suicide, like random violence, is an epidemic. Secretary Panetta has committed the military to lead in developing neuroscience-based technologies to solve this problem, as it led before in developing space vehicles, GPS, and even the internet.

In recent years, U.S. physicians and entrepreneurs have seen some success with the development of a powerful set of personalized medicine tools to help give physicians some of the objective information they need. Having seen the breakthroughs in cancer and heart disease treatments made possible by cheap computing technology and outcome registries, we are now generating better indicators of treatment response through crowd-sourcing and data mining. CNS (Central Nervous System) Response has developed a technology that can drastically reduce the guess work faced by psychiatrists when prescribing drug treatments to mental health patients.

And the technology has demonstrated great success, with clinical outcomes 2-3 times better than the current trial and error treatment. Walter Reed National Military Medical Center begins using the technology in a 2,000 soldier pilot program in early 2013.

Using the latest technology to end trial and error treatments is only the beginning of what U.S. physicians and entrepreneurs can do. Technology has helped so many other medical diseases, it’s time to use it for mental illness too.

George Carpenter is President and Chief Executive Officer of CNS Response, which provides reference data and analytic tools for clinicians and researchers in psychiatry.

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