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Access to a small number of data packages for candidate agents has already been attained and interest in some of the 9 drugs so far collected is already apparent.
Over the past three years, The Medicine Chests Initiative has been taking shape, the purpose of which is to gain access to ‘failed’ compounds and facilitate their reinvestigation, ideally in clinical experimental studies. Indeed, should it be necessary, resynthesis of interesting compounds is being and could be considered (albeit via. research grants) should an agent no longer be physically available. As these agents have already been administered in patients, toxicological studies are unlikely to be needed, as toxicology reports are included in the Medicines Chest repository.
As Dr Ann Hayes, UK, explained, access to a small number of data packages for candidate agents has already been attained and interest in some of the 9 drugs so far collected is already apparent.
Dr Trevor Robbins, UK, outlined how he has applied for a research grant to investigate whether a D1 receptor antagonist previously developed in Alzheimer’s disease might be used both to further investigate the basic science underlying D1 receptor antagonism and also the effect of this drug on cognition – an area of research in which it has not previously been investigated in clinical patients but one now considered worth of pursuit.
To find out more about the Medicines Chest and the agents available go to https://www.ecnp.eu/projects-initiatives/ECNP-medicines-chest.aspx
What does a pharmaceutical company do with a psychotherapeutic drug once it fails in clinical trials? As often as not, it bins it.
“The real challenge in treating MDD is choosing the right option first time,” said Dr Virginia Soria, Spain, “and making sure that the balance between effect and tolerability works right from the start of therapy.” As she explains, in this way benefit can be gained from the outset and long-term issues such as the worsening or persistence of symptoms can be avoided.
In her experience, the best approach is to treat intensively. Therapies should be tailored to take into the account the severity of the patient’s depression, their age and the type of symptoms being experienced. Achieving a partial response or the persistence of residual symptoms is not the end-point of the treatment, especially in certain subgroups of MDD such as melancholic depression. “We have to get the most out of therapy as early as we can,” she said. And to do this establishing a relationship of trust with the patient is essential. This involves the patient being empowered in the management of the condition and to be a willing participant in their treatment programme.
Dr Soria defines remission in MDD when there are few or no mood symptoms present in a patient as measured using a suitable rating scale. However, while remission is desired, recovery is her ultimate goal – that is a complete, sustained remission with functional restoration in the patient. She estimates that 30-40% of patients attain remission at the first attempt. In those that do not initially remit, further interventions are employed including use of combinations of therapies, augmentation and neuromodulation. Use of ECT can lead to attainment of remission in 70% of those in which it is being used. “Don’t stop treatment after the first attempt,” she said, “If a patient is resistant to antidepressant therapy, re-evaluate them with an open mind and look for the treatment regimen that better suits them.”
Dr Soria believes in the use of a more holistic approach to the management of MDD as it has been reliably demonstrated that psychopharmacology and psychotherapy in combination is more effective in gaining symptom remission than either therapy used alone. Ideally, combination therapy should be used from the outset of treatment. This also includes offering advice on lifestyle management including diet and exercise. “It can often take longer to persuade a patient to exercise than to take their medicine!” she reported.
Currently, Dr Soria evaluates cognitive symptoms in depression mainly in her elderly patients using the Mini-mental state examination or MoCA Montreal scales but, as cognitive symptoms affect global performance and functionality regardless of age, she plans to pay more attention to the assessment of these in future in all patients with depression.
Interview with Dr Virginia Soria, Barcelona