Drug development in psychopharmacology: Insights from evolutionary psychiatry

• Published in: Neuroscience and biobehavioral reviews 2024-09, Vol.164, p.105818, Article 105818
• Main Author: Troisi, Alfonso
• Format: Article
• Language: English
• Subjects: Biological Evolution; Clinical phenotypes; Drug Development; Evolutionary psychiatry; Functional capacities; Humans; Mental Disorders - drug therapy; Psychiatry - methods; Psychopharmacology; Psychotropic Drugs - pharmacology; Psychotropic Drugs - therapeutic use; Social context; Symptomatic therapy; Symptoms
• ISSN: 0149-7634; 1873-7528; 1873-7528
• DOI: 10.1016/j.neubiorev.2024.105818

In the last decade, no other branch of clinical pharmacology has been subject to as much criticism of failed innovation and unsatisfactory effectiveness as psychopharmacology. Evolutionary psychiatry can offer original insights on the problems that complicate pharmacological research. Considering that invalid phenotyping is a major obstacle to drug development, an evolutionary perspective suggests targeting clinical phenotypes related to evolved behavior systems because they are more likely to map onto the underlying biology than constructs based on predetermined diagnostic criteria. Because of their emphasis on symptom remission, pharmacological studies of psychiatric populations rarely include functional capacities as the primary outcome measure and neglect the impact of social context on the effects of psychiatric drugs. Evolutionary psychiatry explains why it is appropriate to replace symptoms with functional capacities as the primary target of psychiatric therapies and why social context should be a major focus of studies assessing the effectiveness of drugs currently used and new drugs under development. When the focus of research shifts to those questions that go beyond the “disease-based” concept of drug action, evolutionary psychiatry clearly emerges as a reference framework to assess drug effectiveness and to optimize clinicians’ decisions about prescribing, deprescribing, and non-prescribing. •Focusing on behavior systems can improve the definition of clinical phenotypes.•Drug therapy should target functional impairment, not only symptoms.•Symptomatic therapy may interfere with the enactment of adaptive reactions.•Social context should be a major focus of studies assessing the effectiveness of drugs.•Evolutionary psychiatry questions the “disease-based” model of drug action.