Novel Targets, Novel Meds

"You can mess all you want with serotonin and dopamine, etc," Dr Manji observed, "but if you don't have the appropriate [cell] circuitry in place it's not going to have any effect." This suggests a new generation of drugs that would exploit bcl-2 or other elements of the neuroprotective equation. For the first time, treatment would not be simply based on alleviation of symptoms, but would address the underlying processes that make our brains so vulnerable in the first place. Two current non-mood drugs on the market may provide a preview of what's in store for the future. One, the anticancer drug Novladex (tamoxifen), which inhibits the PKC pathway that is implicated in cellular excitability, was found to have a significant antimania effect in one small study. And the ALS drug Rilutek (riluzole), a glutamate inhibitor, has "a remarkable antidepressant effect."

Hopefully, the day will come when Dr Manji has to disclose a long list of pharmaceutical company associations every time he speaks. That way we'll know for sure that the industry is serious about breaking off its 50-year affair with the neurotransmitter. That day can't come too soon.

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