Placebo response rate is ruining drug development in psychiatry: why is this happening and what can we do about it?

Abstract

Psychopharmacology’s ‘Golden Era’ of the 1990s and early 2000s is over. The soaring placebo response rate combined with the lack of novel validated drug targets has ended it. Big Pharma have now largely abandoned psychiatry. The first ‘Golden Era’ of Psychopharmacology in the 1960s and 1970s ended when the therapeutic targets of that era became saturated, and not because the placebo response rate skyrocketed. Innovation was rejuvenated into a second ‘Golden Era’ by agents with fewer side-effects, not really by novel targets, yet on the back of a clinical testing methodology that robustly and consistently distinguished active agents from placebo. Will there be a third ‘Golden Era?’ Indeed, there is hope that academia and small pharma will find the novel targets for the future, but how can innovation be rejuvenated into a third ‘Golden Era’ with novel targets if we cannot tell active agents from placebo?