Dr Anil K. Ratty and Dr Michael Entzeroth speak on the landscape of mental illness in Asia and the road to solving a burgeoning issue
The exact cause of many diseases of the central nervous system is not precisely known, but research over the last decades has significantly increased the understanding. In many cases, a mixture of different causes can be identified, be it genetic (hereditary), psychological and/or environmental reasons or an imbalance of neurotransmitters in the brain that regulate behaviour. These neurotransmitters include, to name a few, dopamine, norepinephrine, serotonin and glutamate or non-amino acid transmitters such as acetylcholine or gamma-amino butyric acid (GABA).
Mental disorders are the result of multifactorial interactions and a single mechanism can rarely be attributed as a cause to a disease. Drug candidates have been developed and registered for treatment based on the knowledge at time of discovery and the effects of molecules seen in the laboratory. The imbalance of the effect on brain neurotransmitters may leave certain disease aspects unchanged. An example is that many current antidepressants do not affect the dopaminergic signalling and thereby fail to sufficiently improve mood in these patients.
In 2011, the World Health Organization (WHO) published a report on the burden of mental disorders. The availability of treatment to people with insufficient financial capabilities, the violation of human rights for people with mental diseases, such as inadequate hygiene, and the insufficient response to treatment are among the main issues. Insufficient response to treatment can include failure to respond to two or more medications as well as remaining or increased suicidal behaviour when treated. It is obvious that no matter how rich or poor, it is true that most people who die by suicide suffer from a mental or emotional disorder.
More recently, a slew of high profile suicides has raised the awareness of depression and mental illnesses. These illnesses do appear in societies, and awareness is the first step to helping those suffering from such diseases.
Often time, there are neglects on serious mental health conditions and a lack of attention on research and development to solve these issues. Patients of these illnesses often suffer in silence and are left behind in society. In order to improve the quality of life for patients who suffer from mental illnesses, they must be provided improved and safer medicines.
Government policies can help by inciting and supporting biopharmaceutical ingenuity so that improved treatments can be formulated and lives can be improved.
Although much of Asian policy, especially in Singapore, Japan, China, India and Indonesia, has started to recognise the severity of mental illnesses over the last few years, current policies are focused more on awareness and providing proper facilities for those affected. What is needed of these policies is greater consideration on building a foundation towards fulfilling the promise of de-institutionalising patients. The solutions lie in providing effective treatments to help them reintegrate into society and have better quality of life.
Companies can overcome the current barriers of the biopharmaceutical sector, which include financial, scientific and operational adversity, by adopting more efficient development models and testing processes.
Drug development is a rewarding but a highly regulated and demanding process due to the time taken to reach the market and the mitigation of risks involved. In drug development, we have to realize that it takes more than a decade for the development to market entry, a period which requires substantial financial resources. The risk of failure is high during this period and a risk-mitigation strategy is required to improve the chances of success. Overall, a solid financial basis combined with stringent quality control measures is the best foundation.
The drug development process begins with the selection of drug candidates through thorough testing of a large number of molecules and optimizing the selection for higher efficacy and lower side effects, with the patient’s safety being a priority.
For Cennerv Pharma, compounds have been selected that have shown efficacy in animal models of disease or in humans suffering from a particular illness of the central nervous system. It is ensured that there is robust intellectual property covering the compounds.
They adopt a virtual drug development model which maximises efficiency as they engage third-party Contract Research Organisations (CROs) to carry out drug development work.
Over the years, the pharmaceutical industry has evolved from a one-size fits all solution to a more customised approach. As scientific research advances our understanding of the mental illnesses at the molecular and genetic level, we expect to be able to provide safer therapeutic solutions customised for the patients and to alleviate the effects of such illnesses.
Dr Anil K. Ratty is the chairman, executive director and CEO at Cennerv Pharma.
Dr Michael Entzeroth is the chief scientific officer and chief operating officer at Cennerv Pharma.