Steve Levine, MD, discusses what unmet needs remain in major depressive disorder and how the advancements of the last decade are seeking to fill the holes that remain.
Steve Levine, MD, founder and CEO of Actify Neurotherapies: We have a number of exciting things on tap. We really want to target our treatments towards those with treatment-resistant conditions - things like depression, bipolar depression, post-traumatic stress disorder (or PTSD), obsessive-compulsive disorder (or OCD), some chronic pain conditions - really, areas where there are unmet needs and where treatments [are lacking] a lot of variety.
There aren't a lot of options for people because most things that have been developed over the past 50 years have been remarkably similar to each other. There are differences - mostly in terms of side effect profiles and the way that people metabolize these medicines - but as far as their mechanisms, they're quite similar. Fortunately, over the past decade or so, research has led us to new options that are giving people tremendous hope and are really spurring a lot of innovation now in research and development.
The biggest thing that's changed about major depressive treatment since I entered the space was the expectation for how long it should take for treatments to work because a decade ago, the expectation was that you would take oral medication every day - oftentimes multiple times per day - and not expect to see any benefit from that for weeks, or maybe even months. With the success of intravenous ketamine and the promise of rapid-acting therapeutics, ketamine, potentially, can help within hours of a single treatment. There is now the expectation that we should be developing new treatments that work just as quickly, or at least much more quickly, than the orally older oral medications did.
That's tremendous because, with conditions like post-traumatic stress disorder or major depressive disorder, people are in a very dangerous situation. It's not always screamingly obvious as people suffer quietly and they tend to isolate themselves, so we don't necessarily see the suffering that they'll go through. But they're in a very dangerous spot because these conditions put you at high risk for suicide, not to mention that we know that untreated depressive and anxiety disorders are tightly linked to medical comorbidities. People with untreated depression and anxiety have much higher rates of cardiovascular disease, diabetes, cancer, etc. Their expected lifespan is much shorter, and so really isn't any time to lose. So it's become increasingly important for there to be rapid-acting therapies, and now there actually are some examples of treatments that fit that bill.