What Lies On The Horizon For Mental Health Science?

Developed nations around the world are facing an unprecedented mental health crisis. Policymakers are facing a struggle to tackle a problem with complex origins and many continue to suffer in the meantime. A burdensome regulatory process prevents effective treatments from going mainstream in many cases. Take for instance repetitive transcranial magnetic stimulation (rTMS) --- a cutting-edge treatment employed using a device that is capable of stimulating sections of the brain to reduce symptoms of depression. The technology in its modern form has existed since 1985 but only attained FDA approval in 2015. The high burden for scientific evidence slows the adoption of helpful technologies to a snail's pace. Large-scale studies are prohibitively costly to carry out but nevertheless, they are a crucial step in the regulatory process. The rationale of the FDA is clear ---- for a new treatment for mental illness to reach the market it must be categorically proven to be both effective and safe. Perhaps a greater hurdle than this is the attitude of insurers and health services to a form of treatment that is relatively expensive. In Europe, where many health services are provided by governments, strained budgets force hospitals to prioritize urgent care over expensive mental health technology. A similar yet distinct issue arises in countries with private healthcare systems. US insurers are reluctant to approve new treatments and when they do, much of the cost is passed on to the patient. People with debilitating mental health issues are often unable to meet the cost of treatments they direly need. The reason is clear in these cases: severe mental illness cripples sufferers to the extent that they are unable to work and unable to come up with the funds to proceed with treatment. In the meantime, many consumers turn to cheaper alternatives. One burgeoning sector of the multi-billion dollar supplement industry is experimental 'nootropics'. These substances bypass FDA approval and carry claims of effectiveness in tackling issues like depression and anxiety. Again, the slow emergence of high-quality scientific studies hinders our ability to truly gauge the quality of these products. This issue was neatly illustrated in an article exploring the causes driving this emerging segment of the dietary supplement market. S-adenosyl-L-methionine (SAMe) is one nootropic that has caught the attention of manufacturers and consumers alike. In many countries around the world, this naturally occurring compound is regulated by governments. In the United States, however, it is freely available for anyone to purchase. Products of this nature inevitably court controversy and polarization because for every proponent there is at least one detractor. For many, the prospect of getting well is worth the toll of experimentation. Still, others claim that nootropics are simply a cleverly marketed and unproven fraud. So do these products represent a lifeline or are they merely an exploitative scheme? One thing we do know for sure is that mental health sorely needs greater attention in healthcare systems across the world. Patients readily turn to alternative treatments when they fail to receive proper care. Science continues to play catch-up when it comes to medical advances and the onus is on us as voters to back moves to invest more heavily in mental health services. In 2016, just under 45,000 people committed suicide in the United States alone. This is a staggering number of lives lost and the repercussions for loved ones are inestimable as well. 15% of people in the developed world will suffer from major depressive disorder at some point in their life. Up to 8% of depression sufferers take their own lives. The tragedy, of course, is that depression is a treatable illness and we have the tools available to tackle this problem head on if we show the willingness to work toward solutions and invest in a brighter future for sufferers.