Tooting from San Francisco - I

Today, Monday, 4 AM: What the hell am I doing wide awake this time in the morning? Let’s pick up from where I left off yesterday.

Yesterday, Sunday, 1 PM: I touch down at San Francisco Airport, collect my bag, and take the BART into town. My hotel is a fleabag in a colorful part of town within walking distance of the Muscone Center where the American Psychiatric Association annual meeting is taking place.

Sunday, 3 PM: I pick up my media credentials at the conference, shake the sleep out of my system, and plot my next course of action. Nothing much going on, so I head out to the exhibit hall. Pharma’s out in force, but it is looking like their last hurrah. Conspicuously absent is GSK (Lamictal, Wellbutrin, Paxil), which pulled out a year or two ago, along with Abbott (Depakote) and Novartis (Tegretol). All their drugs, of course, are off-patent.

Bristol-Myers Squibb is there by virtue of Abilify, which is still on-patent, along with Astra-Zeneca, with its blockbuster Seroquel. Eli Lilly is no longer flying their Zyprexa and Prozac flags - they have set up their tent by virtue of Cymbalta. Other companies are looking tired trying to generate excitement over new versions of old products.

There is very little taste of the future in the exhibit hall. The biotech companies, with nothing to market, are nowhere in sight. Neuronetics, which recently obtained FDA approval to treat depression with an rTMS device, is basically showing off a new application of an old technology.

In short, for now, the party is over.

6:30 PM: I feel a desperate urge break Rip Van Winkle’s record. Nevertheless, I grab a seat at the grand ballroom of the Hilton Hotel, where Shire is sponsoring a dinner symposium on the pathophysiology of ADHD. This is the last year of industry-sponsored symposia at the APA. Reform is in the air, but the truth is Pharma has lost interest in staging these events. Over the years, as meds have gone off-patent, fewer and fewer of these events have been staged.

Industry-sponsored symposia are a mixed bag. Some of them come across as infomercials, but tonight’s presentation is outstanding. A panel of experts - mainly from Harvard - articulate the underlying biology to ADHD, both on the cellular level (namely what happens when a neuron fails to correctly process information that dopamine is supposed to be delivering) and on a systems level (such as when certain parts of the brain aren’t talking to each other).

Brain scan technology has revolutionized mental illness research. I’m seeing it in all fields - depression, stress, schizophrenia, bipolar, personality disorders, you name it, most of it having taken place in the last three or four years. Thanks to MRI technology, we can now see structural abnormalities in the brain compared to healthy subjects, as well as functional deficits. Example:

A slide of the anterior cingulate cortex goes up. The ACC plays a major role in modulating thoughts - in selecting relevant ones and filtering out irrelevant ones - and is wired into both the thinking cortical areas and primitive reacting limbic system. A series of superimposed markers represents the ADHD brain scan studies performed on this area of the brain. Significantly, the study results testing for an emotional response show activity in the bottom half of the ACC while the study results testing for cognitive response show activity at the top.

Many individuals with bipolar also display cognitive deficits, so what I am learning tonight is shedding light on my own illness.

This is why I am here, to listen to smart people who have dedicated their lives to improving mine. Five minutes into the first presentation and I am wide awake. Last week I got tied down in doing stories about idiots - people like Andy Behrman who have walked away with $400,000 by lying to us, people like Pat Risser who pushes an antipsychiatry agenda predicated on the belief that there is no science to support the concept of mental illness.

Those idiots are irrelevant, as are those who try to legitimize them. Before our very eyes, a picture of the brain at work is emerging, one that is displaying a dramatic interplay between genes, biology, environment, and symptoms/behaviors. This is the real story, the one we need to be paying attention to.

This is the story of the future, as in terms of new drug development. But it’s also the story of the here and now, as in putting recovery principles into practice.

9:15 PM: I’m back in my fleabag hotel, just one block from the Hilton. I flop onto the mattress and am asleep before my head hits the pillow.

Today, 4 AM: The reason I’m awake right now is obvious. I crashed three hours earlier than usual, and had a much sounder sleep. But later today my brain will demand a settling of accounts.

This morning I head out to hear the legendary Kenneth Kendler expound on psychiatric genetics, then the highly-acclaimed author Elyn Saks discuss her journey through madness. Later on, the DSM, new research, and other cool stuff. No way I can sleep through this ...