By Mackenzie Smith, C2ST Intern, Loyola University

What comes to mind when you think of schizophrenia? Movies and TV shows paint a picture of uncontrollable and disturbing visions, or even threatening thoughts and actions. The reality is that these are misconceptions – the vast majority of people who are diagnosed with schizophrenia are not violent and deal with challenges in socialization and cognition. Currently, there are nearly 3 million people in the United States living with schizophrenia and struggling to find medications that allow them to live stable lives. However, new hope is just around the corner. In September, a new antipsychotic treatment was approved by the FDA for the first time in decades. Why the rollout of a new therapeutic took so long gives us a peek into the difficulties of developing ways to treat any illness, and why mental illness is often left behind.

Schizophrenia was first described in 1887 by the psychiatrist Dr. Emile Kraepelin. While many may recognize symptoms such as delusions or hallucinations, it is also marked by low moods and a lack of motivation to accomplish everyday tasks. In the past, scientists thought that schizophrenia is caused by an imbalance of signaling by the “pleasure chemical” of the brain, dopamine, or the mood regulator, serotonin. The first treatments that came about blocked these signals. While they help stabilize some aspects of schizophrenia, these medications also come with unwanted side effects. Patients can experience weight gain, uncontrolled movements like jerks or tics, or a sedated feeling, which can all discourage a person from continuing the treatment. Unfortunately, the challenges posed when developing new medications would leave patients with only these options for over 70 years. 

In the last decade or so, many major pharmaceutical companies have severely cut funding for or eliminated their programs in neuroscience research and development. A complex mix of factors is to blame. For instance, these illnesses are hard to model at the basic science level. Scientists can’t ask a laboratory rat how he feels, making it hard to assess mood changes. Clinical trials can also be tricky, as real life, outside a laboratory environment, is messy. Confusing, variable results in people can keep a drug from being put out on the market. Lastly, the origins of why some people have psychiatric illnesses are hazy. Likely, there is not one genetic mutation or biological basis for schizophrenia. Other disorders like anxiety and depression share these same issues in creating effective treatments. Because of this, it’s hard for scientists to know what to target in the brain to help those struggling.

Despite these challenges, dedicated scientists have worked tirelessly towards a better quality of life for these patients. Thanks to their efforts we now have a new antipsychotic that takes a different approach to easing schizophrenia symptoms. Its origins stem from work done in the 1980s and 1990s which showed that boosting messages sent by the brain chemical acetylcholine is helpful for memory and social behavior. Years of learning how to cleverly tweak this therapeutic to make it safer would follow to finally produce Cobenfy, which was approved at the end of September. 

Scientists have long acknowledged that broader antipsychotic medicine options are needed for those with schizophrenia. Clinical trials show promise that Cobenfy can ease symptoms like hallucinations and anxiety, and may benefit those who don’t respond well to other treatments they have tried. It is important to keep in mind that this drug may not work perfectly for everyone, as some patients may experience side effects including nausea, dizziness, or even vomiting. Still, for the first time in decades, those with schizophrenia have another choice when working with their psychiatrist to see what’s right for them. This exciting development is a win not only for this community but also paves the way for renewed interest in treating mental illnesses.

Resources

1. https://www.healthline.com/health/schizophrenia/are-schizophrenics-violent#risk-factors
2. https://www.tac.org/reports_publications/schizophrenia-fact-sheet/#:~:text=Schizophrenia%20is%20a%20chronic%20and,States%20aged%2018%20or%20older.
3. https://www.mentalhealth.com/library/historical-contemporary-understandings-schizophrenia#:~:text=The%20first%2C%20formal%20description%20of,praecox%20means%20%E2%80%9Cearly%20dementia%E2%80%9D.
4. https://www.sciencedirect.com/science/article/abs/pii/S027858462200118X?via%3Dihub
5. https://www.ncbi.nlm.nih.gov/books/NBK519503/#:~:text=First%2Dgeneration%20antipsychotics%20are%20dopamine,also%20known%20as%20atypical%20antipsychotics
6. https://www.aafp.org/pubs/afp/issues/2010/0301/p617.html
7. https://www.nature.com/articles/d41573-024-00155-8#:~:text=The%20fixed%2Ddose%20combination%20of,disease%20beyond%20dopamine%2Dtargeted%20therapies
8. https://www.biopharmadive.com/news/pharma-neuroscience-retreat-return-brain-drugs/570250/
9. https://jamanetwork.com/journals/jamaneurology/article-abstract/594526#google_vignette
10. https://cen.acs.org/pharmaceuticals/drug-development/FDA-approves-Cobenfy-firstclass-schizophrenia/102/web/2024/09
11. https://www.bu.edu/articles/2024/a-game-changing-new-drug-for-schizophrenia/
12. https://www.fda.gov/news-events/press-announcements/fda-approves-drug-new-mechanism-action-treatment-schizophrenia