TEDxNewYork
Rebecca Brachman: Could a drug prevent depression and PTSD?
Filmed:
Readability: 4.6
1,563,420 views
The path to better medicine is paved with accidental yet revolutionary discoveries. In this well-told tale of how science happens, neuroscientist Rebecca Brachman shares news of a serendipitous breakthrough treatment that may prevent mental disorders like depression and PTSD from ever developing. And listen for an unexpected -- and controversial -- twist.
Rebecca Brachman - Neuroscientist, writer, entrepreneur
Rebecca Brachman is a pioneer in the field of preventative psychopharmacology, developing drugs to enhance stress resilience and prevent mental illness. Full bio
Rebecca Brachman is a pioneer in the field of preventative psychopharmacology, developing drugs to enhance stress resilience and prevent mental illness. Full bio
Double-click the English transcript below to play the video.
00:13
This is a tuberculosis ward,
0
1060
3015
00:16
and at the time this picture was taken
in the late 1800s,
in the late 1800s,
1
4100
3816
00:19
one in seven of all people
2
7939
2617
00:22
died from tuberculosis.
3
10580
1760
00:24
We had no idea
what was causing this disease.
what was causing this disease.
4
12780
2760
00:28
The hypothesis was actually
5
16140
2056
00:30
it was your constitution
that made you susceptible.
that made you susceptible.
6
18220
3256
00:33
And it was a highly romanticized disease.
7
21500
2736
00:36
It was also called consumption,
8
24260
2816
00:39
and it was the disorder of poets
9
27100
3136
00:42
and artists and intellectuals.
10
30260
2736
00:45
And some people actually thought
it gave you heightened sensitivity
it gave you heightened sensitivity
11
33020
3736
00:48
and conferred creative genius.
12
36780
2200
00:52
By the 1950s,
13
40700
2136
00:54
we instead knew
that tuberculosis was caused
that tuberculosis was caused
14
42860
2576
00:57
by a highly contagious
bacterial infection,
bacterial infection,
15
45460
3376
01:00
which is slightly less romantic,
16
48860
2176
01:03
but that had the upside
17
51060
2256
01:05
of us being able to maybe
develop drugs to treat it.
develop drugs to treat it.
18
53340
3336
01:08
So doctors had discovered
a new drug, iproniazid,
a new drug, iproniazid,
19
56700
3016
01:11
that they were optimistic
might cure tuberculosis,
might cure tuberculosis,
20
59740
3376
01:15
and they gave it to patients,
21
63140
1776
01:16
and patients were elated.
22
64940
1776
01:18
They were more social, more energetic.
23
66740
3496
01:22
One medical report actually says
they were "dancing in the halls."
they were "dancing in the halls."
24
70260
4600
01:27
And unfortunately,
25
75500
1616
01:29
this was not necessarily
because they were getting better.
because they were getting better.
26
77140
2720
01:32
A lot of them were still dying.
27
80420
2200
01:35
Another medical report describes them
as being "inappropriately happy."
as being "inappropriately happy."
28
83660
6600
01:43
And that is how the first
antidepressant was discovered.
antidepressant was discovered.
29
91220
3600
01:47
So accidental discovery
is not uncommon in science,
is not uncommon in science,
30
95980
4056
01:52
but it requires more
than just a happy accident.
than just a happy accident.
31
100060
3136
01:55
You have to be able to recognize it
for discovery to occur.
for discovery to occur.
32
103220
3440
01:59
As a neuroscientist,
I'm going to talk to you a little bit
I'm going to talk to you a little bit
33
107500
2736
02:02
about my firsthand experience
34
110260
1416
02:03
with whatever you want to call
the opposite of dumb luck --
the opposite of dumb luck --
35
111700
3216
02:06
let's call it smart luck.
36
114940
1616
02:08
But first, a bit more background.
37
116580
2720
02:12
Thankfully, since the 1950s,
38
120460
2656
02:15
we've developed some other drugs
and we can actually now cure tuberculosis.
and we can actually now cure tuberculosis.
39
123140
3976
02:19
And at least in the United States,
though not necessarily in other countries,
though not necessarily in other countries,
40
127140
3655
02:22
we have closed our sanitoriums
41
130820
1496
02:24
and probably most of you
are not too worried about TB.
are not too worried about TB.
42
132340
3680
02:28
But a lot of what was true
in the early 1900s
in the early 1900s
43
136900
2656
02:31
about infectious disease,
44
139580
1856
02:33
we can say now
about psychiatric disorders.
about psychiatric disorders.
45
141460
2640
02:36
We are in the middle
of an epidemic of mood disorders
of an epidemic of mood disorders
46
144820
3016
02:39
like depression and post-traumatic
stress disorder, or PTSD.
stress disorder, or PTSD.
47
147860
3760
02:44
One in four of all adults
in the United States
in the United States
48
152300
3856
02:48
suffers from mental illness,
49
156180
1480
02:50
which means that if you haven't
experienced it personally
experienced it personally
50
158180
3136
02:53
or someone in your family hasn't,
51
161340
2296
02:55
it's still very likely
that someone you know has,
that someone you know has,
52
163660
3256
02:58
though they may not talk about it.
53
166940
1640
03:02
Depression has actually now surpassed
54
170220
3296
03:05
HIV/AIDS, malaria, diabetes and war
55
173540
4856
03:10
as the leading cause
of disability worldwide.
of disability worldwide.
56
178420
3256
03:13
And also, like tuberculosis in the 1950s,
57
181700
3616
03:17
we don't know what causes it.
58
185340
2056
03:19
Once it's developed, it's chronic,
59
187420
1936
03:21
lasts a lifetime,
60
189380
1496
03:22
and there are no known cures.
61
190900
2320
03:26
The second antidepressant we discovered,
62
194660
2216
03:28
also by accident, in the 1950s,
63
196900
2456
03:31
from an antihistamine
that was making people manic,
that was making people manic,
64
199380
3200
03:35
imipramine.
65
203860
1200
03:38
And in both the case of the tuberculosis
ward and the antihistamine,
ward and the antihistamine,
66
206220
3656
03:41
someone had to be able to recognize
67
209900
1696
03:43
that a drug that was designed
to do one thing --
to do one thing --
68
211620
2416
03:46
treat tuberculosis
or suppress allergies --
or suppress allergies --
69
214060
2576
03:48
could be used to do
something very different --
something very different --
70
216660
2736
03:51
treat depression.
71
219420
1200
03:53
And this sort of repurposing
is actually quite challenging.
is actually quite challenging.
72
221380
3016
03:56
When doctors first saw
this mood-enhancing effect of iproniazid,
this mood-enhancing effect of iproniazid,
73
224420
3936
04:00
they didn't really recognize
what they saw.
what they saw.
74
228380
2456
04:02
They were so used to thinking about it
75
230860
1856
04:04
from the framework
of being a tuberculosis drug
of being a tuberculosis drug
76
232740
2776
04:07
that they actually just listed it
77
235540
2056
04:09
as a side effect, an adverse side effect.
78
237620
2776
04:12
As you can see here,
79
240420
1151
04:13
a lot of these patients in 1954
are experiencing severe euphoria.
are experiencing severe euphoria.
80
241596
4024
04:18
And they were worried
that this might somehow interfere
that this might somehow interfere
81
246900
3616
04:22
with their recovering from tuberculosis.
82
250540
2856
04:25
So they recommended that iproniazid
only be used in cases of extreme TB
only be used in cases of extreme TB
83
253420
6256
04:31
and in patients that were
highly emotionally stable,
highly emotionally stable,
84
259700
3680
04:36
which is of course the exact opposite
of how we use it as an antidepressant.
of how we use it as an antidepressant.
85
264220
3896
04:40
They were so used to looking at it
from the perspective of this one disease,
from the perspective of this one disease,
86
268140
4456
04:44
they could not see the larger implications
for another disease.
for another disease.
87
272620
3920
04:49
And to be fair,
it's not entirely their fault.
it's not entirely their fault.
88
277380
2696
04:52
Functional fixedness
is a bias that affects all of us.
is a bias that affects all of us.
89
280100
2776
04:54
It's a tendency to only
be able to think of an object
be able to think of an object
90
282900
3456
04:58
in terms of its traditional
use or function.
use or function.
91
286380
2600
05:01
And mental set is another thing. Right?
92
289740
1896
05:03
That's sort of this preconceived framework
93
291660
2016
05:05
with which we approach problems.
94
293700
1776
05:07
And that actually makes repurposing
pretty hard for all of us,
pretty hard for all of us,
95
295500
3256
05:10
which is, I guess, why they gave
a TV show to the guy who was,
a TV show to the guy who was,
96
298780
3536
05:14
like, really great at repurposing.
97
302340
1800
05:16
(Laughter)
98
304660
1880
05:19
So the effects in both the case
of iproniazid and imipramine,
of iproniazid and imipramine,
99
307180
4336
05:23
they were so strong --
100
311540
1376
05:24
there was mania,
or people dancing in the halls.
or people dancing in the halls.
101
312940
2216
05:27
It's actually not that surprising
they were caught.
they were caught.
102
315180
3136
05:30
But it does make you wonder
what else we've missed.
what else we've missed.
103
318340
3480
05:35
So iproniazid and imipramine,
104
323020
2176
05:37
they're more than just
a case study in repurposing.
a case study in repurposing.
105
325220
2416
05:39
They have two other things in common
that are really important.
that are really important.
106
327660
2976
05:42
One, they have terrible side effects.
107
330660
2496
05:45
That includes liver toxicity,
108
333180
2616
05:47
weight gain of over 50 pounds,
109
335820
2976
05:50
suicidality.
110
338820
1776
05:52
And two, they both
increase levels of serotonin,
increase levels of serotonin,
111
340620
4176
05:56
which is a chemical signal in the brain,
112
344820
2336
05:59
or a neurotransmitter.
113
347180
1200
06:01
And those two things together,
right, one or the two,
right, one or the two,
114
349380
2496
06:03
may not have been that important,
115
351900
1616
06:05
but the two together meant
that we had to develop safer drugs,
that we had to develop safer drugs,
116
353540
3736
06:09
and that serotonin seemed
like a pretty good place to start.
like a pretty good place to start.
117
357300
3520
06:13
So we developed drugs
to more specifically focus on serotonin,
to more specifically focus on serotonin,
118
361660
3896
06:17
the selective serotonin
reuptake inhibitors, so the SSRIs,
reuptake inhibitors, so the SSRIs,
119
365580
3656
06:21
the most famous of which is Prozac.
120
369260
2736
06:24
And that was 30 years ago,
121
372020
1976
06:26
and since then we have mostly
just worked on optimizing those drugs.
just worked on optimizing those drugs.
122
374020
3200
06:29
And the SSRIs, they are better
than the drugs that came before them,
than the drugs that came before them,
123
377740
3216
06:32
but they still have a lot of side effects,
124
380980
2096
06:35
including weight gain, insomnia,
125
383100
2896
06:38
suicidality --
126
386020
1200
06:40
and they take a really long time to work,
127
388100
2336
06:42
something like four to six weeks
in a lot of patients.
in a lot of patients.
128
390460
2536
06:45
And that's in the patients
where they do work.
where they do work.
129
393020
2176
06:47
There are a lot of patients
where these drugs don't work.
where these drugs don't work.
130
395220
2856
06:50
And that means now, in 2016,
131
398100
3376
06:53
we still have no cures
for any mood disorders,
for any mood disorders,
132
401500
3816
06:57
just drugs that suppress symptoms,
133
405340
2056
06:59
which is kind of the difference between
taking a painkiller for an infection
taking a painkiller for an infection
134
407420
4056
07:03
versus an antibiotic.
135
411500
1416
07:04
A painkiller will make you feel better,
136
412940
1856
07:06
but is not going to do anything
to treat that underlying disease.
to treat that underlying disease.
137
414820
3080
07:10
And it was this flexibility
in our thinking
in our thinking
138
418700
2336
07:13
that let us recognize
that iproniazid and imipramine
that iproniazid and imipramine
139
421060
2936
07:16
could be repurposed in this way,
140
424020
2096
07:18
which led us to the serotonin hypothesis,
141
426140
1976
07:20
which we then, ironically, fixated on.
142
428140
3000
07:23
This is brain signaling, serotonin,
143
431980
2536
07:26
from an SSRI commercial.
144
434540
1256
07:27
In case you're not clear,
this is a dramatization.
this is a dramatization.
145
435820
2360
07:30
And in science, we try
and remove our bias, right,
and remove our bias, right,
146
438660
4056
07:34
by running double-blinded experiments
147
442740
2376
07:37
or being statistically agnostic
as to what our results will be.
as to what our results will be.
148
445140
3696
07:40
But bias creeps in more insidiously
in what we choose to study
in what we choose to study
149
448860
4296
07:45
and how we choose to study it.
150
453180
1720
07:48
So we've focused on serotonin now
for the past 30 years,
for the past 30 years,
151
456260
3576
07:51
often to the exclusion of other things.
152
459860
2240
07:54
We still have no cures,
153
462860
1360
07:57
and what if serotonin
isn't all there is to depression?
isn't all there is to depression?
154
465180
3416
08:00
What if it's not even the key part of it?
155
468620
2056
08:02
That means no matter how much time
156
470700
2176
08:04
or money or effort we put into it,
157
472900
2736
08:07
it will never lead to a cure.
158
475660
1920
08:10
In the past few years,
doctors have discovered
doctors have discovered
159
478500
2576
08:13
probably what is the first truly new
antidepressant since the SSRIs,
antidepressant since the SSRIs,
160
481100
4920
08:18
Calypsol,
161
486540
1296
08:19
and this drug works very quickly,
within a few hours or a day,
within a few hours or a day,
162
487860
3456
08:23
and it doesn't work on serotonin.
163
491340
1896
08:25
It works on glutamate,
which is another neurotransmitter.
which is another neurotransmitter.
164
493260
2680
08:28
And it's also repurposed.
165
496380
1496
08:29
It was traditionally used
as anesthesia in surgery.
as anesthesia in surgery.
166
497900
3080
08:33
But unlike those other drugs,
167
501540
1656
08:35
which were recognized pretty quickly,
168
503220
1816
08:37
it took us 20 years
169
505060
1696
08:38
to realize that Calypsol
was an antidepressant,
was an antidepressant,
170
506780
2656
08:41
despite the fact that it's actually
a better antidepressant,
a better antidepressant,
171
509460
2856
08:44
probably, than those other drugs.
172
512340
1616
08:45
It's actually probably because of the fact
that it's a better antidepressant
that it's a better antidepressant
173
513980
4096
08:50
that it was harder for us to recognize.
174
518100
1895
08:52
There was no mania to signal its effects.
175
520019
2081
08:54
So in 2013, up at Columbia University,
176
522580
3096
08:57
I was working with my colleague,
177
525700
1576
08:59
Dr. Christine Ann Denny,
178
527300
1976
09:01
and we were studying Calypsol
as an antidepressant in mice.
as an antidepressant in mice.
179
529300
3800
09:05
And Calypsol has, like,
a really short half-life,
a really short half-life,
180
533660
2816
09:08
which means it's out of your body
within a few hours.
within a few hours.
181
536500
3056
09:11
And we were just piloting.
182
539580
1416
09:13
So we would give an injection to mice,
183
541020
2256
09:15
and then we'd wait a week,
184
543300
1296
09:16
and then we'd run
another experiment to save money.
another experiment to save money.
185
544620
2680
09:20
And one of the experiments I was running,
186
548020
2136
09:22
we would stress the mice,
187
550180
1656
09:23
and we used that as a model of depression.
188
551860
2216
09:26
And at first it kind of just looked
like it didn't really work at all.
like it didn't really work at all.
189
554100
3336
09:29
So we could have stopped there.
190
557460
1520
09:31
But I have run this model
of depression for years,
of depression for years,
191
559540
2896
09:34
and the data just looked kind of weird.
192
562460
1896
09:36
It didn't really look right to me.
193
564380
1856
09:38
So I went back,
194
566260
1216
09:39
and we reanalyzed it
195
567500
1496
09:41
based on whether or not they had gotten
that one injection of Calypsol
that one injection of Calypsol
196
569020
3816
09:44
a week beforehand.
197
572860
1200
09:46
And it looked kind of like this.
198
574940
2016
09:48
So if you look at the far left,
199
576980
2136
09:51
if you put a mouse in a new space,
200
579140
2496
09:53
this is the box, it's very exciting,
201
581660
2256
09:55
a mouse will walk around and explore,
202
583940
2136
09:58
and you can see that pink line
is actually the measure of them walking.
is actually the measure of them walking.
203
586100
4296
10:02
And we also give it
another mouse in a pencil cup
another mouse in a pencil cup
204
590420
3176
10:05
that it can decide to interact with.
205
593620
2056
10:07
This is also a dramatization,
in case that's not clear.
in case that's not clear.
206
595700
3216
10:10
And a normal mouse will explore.
207
598940
3696
10:14
It will be social.
208
602660
1240
10:16
Check out what's going on.
209
604620
1376
10:18
If you stress a mouse
in this depression model,
in this depression model,
210
606020
2896
10:20
which is the middle box,
211
608940
1280
10:23
they aren't social, they don't explore.
212
611100
1896
10:25
They mostly just kind of hide
in that back corner, behind a cup.
in that back corner, behind a cup.
213
613020
3280
10:29
Yet the mice that had gotten
that one injection of Calypsol,
that one injection of Calypsol,
214
617020
3096
10:32
here on your right,
215
620140
1200
10:34
they were exploring, they were social.
216
622060
1960
10:36
They looked like they
had never been stressed at all,
had never been stressed at all,
217
624740
2480
10:40
which is impossible.
218
628020
1200
10:42
So we could have just stopped there,
219
630260
1720
10:44
but Christine had also used
Calypsol before as anesthesia,
Calypsol before as anesthesia,
220
632780
4296
10:49
and a few years ago she had seen
221
637100
1576
10:50
that it seemed to have
some weird effects on cells
some weird effects on cells
222
638700
2376
10:53
and some other behavior
223
641100
1216
10:54
that also seemed to last
long after the drug,
long after the drug,
224
642340
3016
10:57
maybe a few weeks.
225
645380
1256
10:58
So we were like, OK,
226
646660
1256
10:59
maybe this is not completely impossible,
227
647940
2176
11:02
but we were really skeptical.
228
650140
1496
11:03
So we did what you do in science
when you're not sure,
when you're not sure,
229
651660
2536
11:06
and we ran it again.
230
654220
1200
11:08
And I remember being in the animal room,
231
656460
3016
11:11
moving mice from box to box
to test them,
to test them,
232
659500
3656
11:15
and Christine was actually sitting
on the floor with the computer in her lap
on the floor with the computer in her lap
233
663180
3616
11:18
so the mice couldn't see her,
234
666820
1416
11:20
and she was analyzing
the data in real time.
the data in real time.
235
668260
2256
11:22
And I remember us yelling,
236
670540
1376
11:23
which you're not supposed to do
in an animal room where you're testing,
in an animal room where you're testing,
237
671940
3296
11:27
because it had worked.
238
675260
1576
11:28
It seemed like these mice
were protected against stress,
were protected against stress,
239
676860
4376
11:33
or they were inappropriately happy,
however you want to call it.
however you want to call it.
240
681260
3056
11:36
And we were really excited.
241
684340
2440
11:39
And then we were really skeptical,
because it was too good to be true.
because it was too good to be true.
242
687820
3480
11:43
So we ran it again.
243
691860
1200
11:45
And then we ran it again in a PTSD model,
244
693740
2736
11:48
and we ran it again
in a physiological model,
in a physiological model,
245
696500
2416
11:50
where all we did was give stress hormones.
246
698940
2216
11:53
And we had our undergrads run it.
247
701180
1616
11:54
And then we had our collaborators
halfway across the world in France run it.
halfway across the world in France run it.
248
702820
4120
11:59
And every time someone ran it,
they confirmed the same thing.
they confirmed the same thing.
249
707780
3216
12:03
It seemed like
this one injection of Calypsol
this one injection of Calypsol
250
711020
2816
12:05
was somehow protecting
against stress for weeks.
against stress for weeks.
251
713860
2760
12:09
And we only published this a year ago,
252
717180
1856
12:11
but since then other labs
have independently confirmed this effect.
have independently confirmed this effect.
253
719060
4080
12:15
So we don't know what causes depression,
254
723940
1920
12:18
but we do know that stress
is the initial trigger
is the initial trigger
255
726460
3696
12:22
in 80 percent of cases,
256
730180
2336
12:24
and depression and PTSD
are different diseases,
are different diseases,
257
732540
2216
12:26
but this is something
they share in common.
they share in common.
258
734780
2016
12:28
Right? It is traumatic stress
259
736820
1816
12:30
like active combat or natural disasters
260
738660
2896
12:33
or community violence or sexual assault
261
741580
2456
12:36
that causes post-traumatic
stress disorder,
stress disorder,
262
744060
2280
12:38
and not everyone that is exposed to stress
develops a mood disorder.
develops a mood disorder.
263
746980
5616
12:44
And this ability to experience
stress and be resilient
stress and be resilient
264
752620
2896
12:47
and bounce back and not develop
depression or PTSD
depression or PTSD
265
755540
4160
12:52
is known as stress resilience,
266
760500
2256
12:54
and it varies between people.
267
762780
1856
12:56
And we have always thought of it
as just sort of this passive property.
as just sort of this passive property.
268
764660
3336
13:00
It's the absence of susceptibility factors
269
768020
2536
13:02
and risk factors for these disorders.
270
770580
2080
13:05
But what if it were active?
271
773620
1880
13:08
Maybe we could enhance it,
272
776420
1496
13:09
sort of akin to putting on armor.
273
777940
2160
13:13
We had accidentally discovered
the first resilience-enhancing drug.
the first resilience-enhancing drug.
274
781220
4600
13:18
And like I said, we only gave
a tiny amount of the drug,
a tiny amount of the drug,
275
786740
2776
13:21
and it lasted for weeks,
276
789540
1576
13:23
and that's not like anything
you see with antidepressants.
you see with antidepressants.
277
791140
3216
13:26
But it is actually kind of similar
to what you see in immune vaccines.
to what you see in immune vaccines.
278
794380
4320
13:31
So in immune vaccines,
you'll get your shots,
you'll get your shots,
279
799180
2936
13:34
and then weeks, months, years later,
280
802140
3376
13:37
when you're actually exposed to bacteria,
281
805540
2336
13:39
it's not the vaccine in your body
that protects you.
that protects you.
282
807900
2456
13:42
It's your own immune system
283
810380
1376
13:43
that's developed resistance and resilience
to this bacteria that fights it off,
to this bacteria that fights it off,
284
811780
4136
13:47
and you actually never get the infection,
285
815940
2136
13:50
which is very different
from, say, our treatments. Right?
from, say, our treatments. Right?
286
818100
3056
13:53
In that case, you get the infection,
you're exposed to the bacteria,
you're exposed to the bacteria,
287
821180
3816
13:57
you're sick, and then you take,
say, an antibiotic which cures it,
say, an antibiotic which cures it,
288
825020
3856
14:00
and those drugs are actually working
to kill the bacteria.
to kill the bacteria.
289
828900
3240
14:04
Or similar to as I said before,
with this palliative,
with this palliative,
290
832780
2496
14:07
you'll take something
that will suppress the symptoms,
that will suppress the symptoms,
291
835300
2856
14:10
but it won't treat
the underlying infection,
the underlying infection,
292
838180
2696
14:12
and you'll only feel better
during the time in which you're taking it,
during the time in which you're taking it,
293
840900
3336
14:16
which is why you have to keep taking it.
294
844260
1936
14:18
And in depression and PTSD --
295
846220
2696
14:20
here we have your stress exposure --
296
848940
1976
14:22
we only have palliative care.
297
850940
2616
14:25
Antidepressants only suppress symptoms,
298
853580
2496
14:28
and that is why you basically
have to keep taking them
have to keep taking them
299
856100
2856
14:30
for the life of the disease,
300
858980
1696
14:32
which is often
the length of your own life.
the length of your own life.
301
860700
2200
14:35
So we're calling our resilience-enhancing
drugs "paravaccines,"
drugs "paravaccines,"
302
863940
4216
14:40
which means vaccine-like,
303
868180
1536
14:41
because it seems
like they might have the potential
like they might have the potential
304
869740
2496
14:44
to protect against stress
305
872260
1816
14:46
and prevent mice from developing
306
874100
3416
14:49
depression and post-traumatic
stress disorder.
stress disorder.
307
877540
2760
14:52
Also, not all antidepressants
are also paravaccines.
are also paravaccines.
308
880780
3440
14:57
We tried Prozac as well,
309
885300
1616
14:58
and that had no effect.
310
886940
1360
15:01
So if this were to translate into humans,
311
889060
3016
15:04
we might be able to protect people
312
892100
2576
15:06
who are predictably at risk
313
894700
2256
15:08
against stress-induced disorders
like depression and PTSD.
like depression and PTSD.
314
896980
3856
15:12
So that's first responders
and firefighters,
and firefighters,
315
900860
3136
15:16
refugees, prisoners and prison guards,
316
904020
4136
15:20
soldiers, you name it.
317
908180
2080
15:23
And to give you a sense
of the scale of these diseases,
of the scale of these diseases,
318
911220
3800
15:27
in 2010, the global burden of disease
319
915620
3056
15:30
was estimated at 2.5 trillion dollars,
320
918700
3840
15:35
and since they are chronic,
321
923060
1536
15:36
that cost is compounding
and is therefore expected to rise
and is therefore expected to rise
322
924620
3216
15:39
up to six trillion dollars
in just the next 15 years.
in just the next 15 years.
323
927860
3240
15:44
As I mentioned before,
324
932460
1579
15:46
repurposing can be challenging
because of our prior biases.
because of our prior biases.
325
934064
4076
15:50
Calypsol has another name,
326
938860
1520
15:53
ketamine,
327
941100
1200
15:55
which also goes by another name,
328
943380
1560
15:57
Special K,
329
945460
1416
15:58
which is a club drug and drug of abuse.
330
946900
2400
16:02
It's still used across the world
as an anesthetic.
as an anesthetic.
331
950540
3096
16:05
It's used in children.
We use it on the battlefield.
We use it on the battlefield.
332
953660
2856
16:08
It's actually the drug of choice
in a lot of developing nations,
in a lot of developing nations,
333
956540
2976
16:11
because it doesn't affect breathing.
334
959540
1856
16:13
It is on the World Health Organization
list of most essential medicines.
list of most essential medicines.
335
961420
4680
16:18
If we had discovered ketamine
as a paravaccine first,
as a paravaccine first,
336
966580
3560
16:22
it'd be pretty easy for us to develop it,
337
970820
2856
16:25
but as is, we have to compete
with our functional fixedness
with our functional fixedness
338
973700
3856
16:29
and mental set that kind of interfere.
339
977580
2800
16:33
Fortunately, it's not
the only compound we have discovered
the only compound we have discovered
340
981700
3856
16:37
that has these prophylactic,
paravaccine qualities,
paravaccine qualities,
341
985580
3440
16:41
but all of the other drugs
we've discovered,
we've discovered,
342
989700
2200
16:44
or compounds if you will,
they're totally new,
they're totally new,
343
992780
2176
16:46
they have to go through
the entire FDA approval process --
the entire FDA approval process --
344
994980
3616
16:50
if they make it before
they can ever be used in humans.
they can ever be used in humans.
345
998620
3576
16:54
And that will be years.
346
1002220
1656
16:55
So if we wanted something sooner,
347
1003900
2256
16:58
ketamine is already FDA-approved.
348
1006180
2376
17:00
It's generic, it's available.
349
1008580
2696
17:03
We could develop it for a fraction
of the price and a fraction of the time.
of the price and a fraction of the time.
350
1011300
4160
17:08
But actually, beyond
functional fixedness and mental set,
functional fixedness and mental set,
351
1016380
4376
17:12
there's a real other challenge
to repurposing drugs,
to repurposing drugs,
352
1020780
3576
17:16
which is policy.
353
1024380
1199
17:18
There are no incentives in place
354
1026179
2216
17:20
once a drug is generic and off patent
and no longer exclusive
and no longer exclusive
355
1028419
3736
17:24
to encourage pharma companies
to develop them,
to develop them,
356
1032179
2337
17:26
because they don't make money.
357
1034540
1429
17:28
And that's not true for just ketamine.
That is true for all drugs.
That is true for all drugs.
358
1036380
3120
17:32
Regardless, the idea itself
is completely novel in psychiatry,
is completely novel in psychiatry,
359
1040579
5657
17:38
to use drugs to prevent mental illness
360
1046260
3896
17:42
as opposed to just treat it.
361
1050180
1360
17:44
It is possible that 20, 50,
100 years from now,
100 years from now,
362
1052740
5056
17:49
we will look back now
at depression and PTSD
at depression and PTSD
363
1057820
4096
17:53
the way we look back
at tuberculosis sanitoriums
at tuberculosis sanitoriums
364
1061940
3216
17:57
as a thing of the past.
365
1065180
1200
17:59
This could be the beginning of the end
of the mental health epidemic.
of the mental health epidemic.
366
1067180
5240
18:05
But as a great scientist once said,
367
1073380
3200
18:09
"Only a fool is sure of anything.
368
1077900
2256
18:12
A wise man keeps on guessing."
369
1080180
2040
18:16
Thank you, guys.
370
1084044
1240
18:17
(Applause)
371
1085780
4066
ABOUT THE SPEAKER
Rebecca Brachman - Neuroscientist, writer, entrepreneurRebecca Brachman is a pioneer in the field of preventative psychopharmacology, developing drugs to enhance stress resilience and prevent mental illness.
Why you should listen
Current treatments for mood disorders only suppress symptoms without addressing the underlying disease, and there are no known cures. The drugs Rebecca Brachman is developing would be the first to prevent psychiatric disorders such as post-traumatic stress disorder (PTSD) and depression.
Brachman completed her PhD at Columbia University, prior to which she was a fellow at the National Institutes of Health, where she discovered that immune cells carry a memory of psychological stress and that white blood cells can act as antidepressants and resilience-enhancers. Brachman's research has been featured in The Atlantic, WIRED and Business Insider, and her work was recently described by Dr. George Slavich on NPR as a "moonshot project that is very much needed in the mental health arena."
In addition to conducting ongoing research at Columbia, Brachman is an NYCEDC Entrepreneurship Lab Fellow and cofounder of Paravax -- a biotech startup developing vaccine-like prophylactic drugs ("paravaccines") -- along with her scientific collaborator, Christine Ann Denny. She is also working on a non-profit venture to repurpose existing generic drugs for use as prophylactics, and previously served as the Interim Program Director for Outreach at the Zuckerman Institute at Columbia University.
Brachman is also a playwright and screenwriter. She holds Bachelor's degrees in both neuroscience and creative wWriting, and she is currently working on a tech-focused writing project with her long-time writing partner, Sean Calder ("Grimm," "Damages," "ER"). She served as the director of NeuWrite, a national network of science-writing groups that fosters ongoing collaboration between scientists, writers and artists, and she has been featured as a storyteller at The Story Collider.
(Photo: Kenneth Willardt)
Rebecca Brachman | Speaker | TED.com