Dr. Charles B. Nemeroff Headlines Capitol Hill Hearings on Depression, Suicide and Opioid Addiction
The American College of Neuropsychopharmacology (ACNP) Liaison Committee, co-chaired by Charles B. Nemeroff, M.D., Ph.D., Leonard M. Miller Professor and Chair of the Department of Psychiatry and Behavioral Sciences, presented a briefing on depression and suicide titled “A Precision Medicine Approach to Mental Illness,” at the Congressional Neuroscience Caucus on June 29. The briefing gave congressional staffers information about the latest research in this area.
Presentations by Helen Mayberg, M.D., professor of psychiatry, neurology and radiology at Emory University, and Beverly Brewster, an attorney who has suffered with severe depression and who is a longstanding patient of Nemeroff’s comprised the program. Speaking to a room of about 50 staffers, Brewster described her experience with the cardinal symptoms of depression, including persistent suicidal thoughts. She explained that many patients like herself often spend years on a medical journey, trying numerous treatment options before finding one, or a combination of treatments, that ultimately results in treatment success. Speaking of her own case, she emphasized the importance of combining appropriate pharmacotherapy and psychotherapy.
“Of all of the top ten causes of death in the United States, only suicide is on the rise,” said Nemeroff. “There were more than 42,000 suicides in the US in 2014, the majority due to untreated, unrecognized or poorly responsive depression. In addition, a multitude of other factors contribute to this situation including obstacles that get in the way of patients who are in need of mental health services. Stigma about psychiatric disorders, lack of recognition of the disorders and a shortage of mental health professionals are also important contributors to the rising rate of suicide. Finally the high rate of suicide in current and former military personnel has not shown any sign of abating.”
Mayberg began her presentation by highlighting the fact that, despite the effectiveness of many antidepressant treatments — both medication and certain forms of psychotherapy — there is no reliable method to match an individual patient to the treatment with the greatest likelihood of success. In psychiatry, as in all of medicine, personalized or precision medicine is being actively investigated with two goals in mind: first, identifying individuals who are at risk for psychiatric disorders, and second, identifying clinically meaningful brain biosignatures that can be used to predict the best treatment for the patient, including that which is the most effective with the least side effects.
Mayberg documented her studies that use functional magnetic resonance imaging to reveal patterns of brain activity predicting response to antidepressant treatment, and other patterns that predict response to certain psychotherapies. These strategies, coupled with ongoing genomic research, may help achieve the goal of more personalized medicine in psychiatry.
The next day, to a standing-room-only, bipartisan crowd, the ACNP Liaison Committee, led by Nemeroff and Natalie Rasgon, M.D., Ph.D., professor of psychiatry and behavioral sciences at Stanford University (who co-chaired both days with Nemeroff), presented “The Nation’s Opioid Addiction and Overdose Crisis.” Presented in cooperation with the office of Senator Lamar Alexander (R-TN), Chair of the Senate Committee on Health, Education, Labor and Pensions, the briefing occurred as opioid legislation that had passed in the House was moving on to the Senate. The goal of the presentation, as with all ACNP briefings, is to educate policy makers on important scientific issues and stress the importance of continued research funding.
Nora Volkow, M.D., Director of the National Institute on Drug Abuse (NIDA) and an ACNP member, presented to the group on how science informs us about the intertwined problems of chronic pain, nonmedical use of prescription pain medicines, heroin use and opioid overdose deaths in the U.S. The misuse of, and addiction to, opioids such as heroin and prescription pain medicines is a serious national problem that affects public health, as well as social and economic welfare. Neuroscience research has provided some solutions to aspects of the problem, but existing evidence-based prevention and treatment strategies are both highly underused and not effective for many patients. Accompanying Volkow was Justin Riley, President and CEO of Young People in Recovery, who offered a patient’s perspective.
“The attendance and response to the briefing has been overwhelmingly positive,” said Nemeroff. “Many of the staffers were appreciative of the education and the efforts of our members’ research in an area of such dire need. It is clear that understanding the pathogenesis of opiate addiction, like all other medical disorders, is the requisite cornerstone for developing novel prevention and treatment strategies.”
Significant efforts have been undertaken across the United States to reduce diversion and misuse of prescription opioids, and to reduce opioid overdoses and related deaths. NIDA supports research to understand the impact of these policy changes on rates of opioid misuse, opioid use disorders and related public health outcomes. This research has demonstrated the efficacy of multiple types of interventions including:
- Educational initiatives delivered in school and community settings (primary prevention) – Supporting consistent use of prescription drug monitoring programs – Implementation of overdose education and naloxone distribution programs to issue naloxone directly to opioid users and potential bystanders – Aggressive law enforcement efforts to address doctor shopping and pill mills – Diverting justice-involved individuals with substance use disorders to drug courts with mandated engagement in treatment – Expansion of access to medication-assisted treatments – Abuse-deterrent formulations for opioid analgesics
Unfortunately the increasing regulation of prescription opiates has had an unintended consequence, namely a marked increase in heroin use, which has further contributed to the alarming overdose death rate due to opiates in the United States.