Alright, this is long and intricate, but hopefully explained in a not so hard to understand manner (because as I always say, I'm just a chick who is interested with a background in "has to study harder than all of her friends to keep up" nom sayin? ;))
It’s been known for quite some time that mental health is something that everyone wants to do better with, but how are we bridging the gap in scientific research to be able to do so. I do think that just like everything it’s become a little nuanced. Many are claiming that they have bipolar disorder due to a mood swing, or depressive disorder just from a day of being sad. Suicide is very hard to study due to the patients no longer being able to share their experiences and most of the time don’t come forward when feeling the way that they are. The habit tracts apply pretty much across the board of mental illness as well. I have not mentioned even a tiny portion of the various mental illnesses, but you can see that when approaching this topic, it can get difficult quickly and each situation must be taken individually.
So, how does the brain work for target drug therapy? That’s the topic of today now that I’ve rambled ;)
The blood brain barrier is known for being very hard to penetrate unless it’s an extremely small molecular structure (for example: caffeine and alcohol). Many molecular structures of drugs are NOT small molecules therefore this hinders most of the medications that want to come to trial even if they would possibly be effective because they wouldn’t make it through. This is good for protection but hard when we want to treat disease. There are tight junctions and endothelium mumbo jumbo science terms that won’t allow for entry, HOWEVER, they are taking neurological disease states such as MS, Alzheimers, cerebral palsy, and others and studying what is happening to allow for leakage and penetration into the blood brain barrier in those times to hopefully help them see how they can get medications for mental illness and neurological diseases to their target sites. (This is kind of sad but there was a review done and there were 7000 pharmaceutical agents that were shown to not effectively cross).
There are many MANY different routes that they are studying to help with mitigating this issue such as nano technology and using transport/carriers to get drugs in to the brain but it is difficult. There are two parts of the bbb that drugs have to work and diffuse across. The first is from the blood stream to the central nervous system and the other is the extracellular space which is the newest area (especially with brain tumor formation) that disrupts the drug delivery to the brain. The third and final stopping point is the specific issue and which areas that are affected in the brain. This can vary across genetics and it can vary across every single mental disease. Recently, scanning techniques have been able to show that there are specific areas that are inflamed during particular mental disorders, but it soon was shown that it doesn’t just affect ONE area of the brain (termed localization) but multiple areas of the brain. It can affect things in the both the pre synapse and post synapse. It can affect neurotransmitters across the board and there are no tests at this time to determine which ones you have trouble with.
You can see just how difficult this becomes. For example, when looking at eating disorders, they are still wildly misunderstood as they are a fairly new disease of the western culture primarily and impact many different areas of the brain including the basal ganglia, insular cortex, amygdala, fronto-striato and the limbic system and different neurotransmitters like dopamine, serotonin, cortisol, and adrenaline. I’m sure I missed others, and the point being — it’s a lot. So to be able to give one drug to target all of this is just not something that is even possible at this time. This is true across the board with disease states that involve the brain and every single one of them is different.
It reminds me when people say that they are “holding out cancer treatment to the public for money” and that’s just not how it works. Every single cancer needs to be treated differently, and one area the above is useful is in brain tumors and how can we get through the BBB using nanotechnology. That’s cancer research. They aren’t withholding it. It just takes forever to get these drugs to trial and technology is slowly (while also quickly) advancing to restructure clinical trials to be faster but remain safe.
There is a GRAVE misnomer that anxiety / depression is a “chemical imbalance.” I’m not saying that it’s not, but there is no testing at this time to test your “chemical imbalance” and most of the time when you go the doctor, they are going to put you on the first recommended drug in the class of SSRI (selective serotonin re-uptake inhibitors). But do you know that you have a serotonin issue? Probably not. What if yours is dopamine or both or norepinephrine or GABA or your inability to control your amygdala or your habit loops in your striatum that causes you to always reach for the XYZ addictive habit that then causes anxiety? It’s.so.complex. So, within that, you just need to be self aware when you begin these medications. If you do not feel that they are working for you, then it’s okay to let your physician know that. It might not mean that there is something else for you to take, but it might also mean that you shouldn’t experience possible side effects from a drug that doesn’t work for you.
I should probably link up some studies so you trust what I say, but bibliographies are for science class, and I'm just not about all that work! LOL! If you have a specific one you'd like to know though, I can totally find it for you! ha!