Changing Minds: Psychedelics as Legitimate Medicine

Welcome to the RTW podcast. I'm your guest host Stephanie Sirota, Partner and Chief Business Officer leading the strategic partnerships team at RTW Investments. Today, I'm speaking with Connor Williams, Senior Research Analyst at RTW responsible for research in neurological disease. Connor, thanks for being with us today. Great to be here. The earliest written accounts of depression date back to Mesopotamia when it was thought that depression was caused by demons. Then the ancient Greeks and Romans thought it was both biological and psychological, and they prescribed exercise, diet, baths, massage, music, and medication. Now they might have been on to something, but as we know, holistic therapies are especially tough to ensure compliance from the patient. So it's down really to the efficacy of the drugs. Most people today think about depression emerging on the scene as a disease with the advent of breakthrough pharmaceuticals in the mid twentieth century with the mau I monoamine oxidase inhibitors. Let me just test your history here. Tell us about that class of drugs. Yeah. What's actually really cool about any drug that affects the brain is a lot of them are discovered by serendipity. So the first antidepressant was actually being developed as a drug to treat tuberculosis, and they found in the patients they gave it to that it had this surprising effect on mood. And that was the first monoamine oxidase inhibitor. And that started this kind of snowball where the monoamine oxidase inhibitors led to tricyclics and then led to, you know, this class of drugs, SSRIs, which have been the mainstay of antidepressant therapy for decades. Prozac was developed by Eli Lilly, and it was the most prescribed antidepressant because it worked and it had this relatively clean side effect profile. But then it feels like there has been a desert of innovation. Psychopharmacology is this constant series of booms and then busts. So you had the nineteen fifties and sixties where you first start getting psychopharmacological medicine. You had this explosion in all these different drugs over the ensuing decades where we went from monomirine oxidase inhibitors to, again, tricyclics and then SSRIs. There's Prozac, which is fluoxetine, and Celexa, which is citalopram, then its successor drug patient that either doesn't respond to an SSRI, which happens all the time, we have millions of people that are treatment resistant in The US, Or you're a patient that gets unacceptable adverse events on an SSRI, you're kind of out of luck. It became a situation where patients weren't getting any better as we made more and more drugs. Pays and physicians kind of caught on, and they said, you know, why am I gonna prescribe this branded drug that works just the same way as this generic drug? Am I really gonna jump through all these insurance hoops to get a drug that's the same? And the answer was no. And so what was a blockbuster market, every drug was a a multibillion dollar drug. You …