Abstract
Significant advances in pharmacological treatments for mental illness and addiction will require abandoning old monoaminergic theories of psychiatric disorders and traditionally narrow approaches to how we conduct treatment research. Reframing our efforts with a view on integrative treatments that target core neural network function and plasticity may provide new approaches for lifting patients out of chronic psychiatric symptom sets and addiction. For example, we discuss new treatments that target brain glutamate systems at key transition points within longitudinal courses of care that integrate several treatment modalities. A reconsideration of what our novel and already available medications are intended to achieve and how and when we deliver them for patients with complex illness trajectories could be the key to unlocking new advances in general and addiction psychiatry.
Highlights
Addiction and mental illnesses are physiologically convergent and causally inter-related diseases of the brain that involve disturbances in decision making, motivation, cognition, stress-responsivity, and social behavior [1,2]
Entertaining the perspective of a neural network lends greater sophistication in contemplating therapeutic interventions, by traditional means such as augmenting neurotransmitter levels or antagonizing receptor engagement, but more so as about altering the structure, function, and plasticity of the neural network, to achieve new functional states [4]. This ‘neural network-as-therapeutic-target’ viewpoint pries open the door to understanding the need for more aggressive pursuit of integrative treatments in brain-behavioral-health
While there is a tradition for a somewhat parsimonious treatment approach in psychiatry (e.g., SSRIs are effective for treating both depression and anxiety disorders), the research community has not extended its efforts far enough, especially when it comes to looking for treatments that target both mental disorders and addictions
Summary
Addiction and mental illnesses are physiologically convergent and causally inter-related diseases of the brain that involve disturbances in decision making, motivation, cognition, stress-responsivity, and social behavior [1,2]. If we intend to develop new medication regimens that more aggressively alter neural network architecture and plasticity more profoundly than traditional medications, we should be researching how the environment and psychosocialexperiences of the patient can be therapeutically optimized during (or in the aftermath of) pharmacologic treatment to ensure better outcomes.
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