New Hope in Mental Health - ‘Caught Between Optimism and Concern’

Carol A. Tamminga, M.D. - Brain & behavior research expert on mental illness
Carol A. Tamminga, M.D.

Dr. Carol Tamminga, Brain & Behavior Research Foundation Scientific Council Member, speaks about the potential of mental health research today

From The Quarterly, Spring 2011

The term ‘translational research’ refers to the translation of research findings into medical treatments based upon understanding the underlying mechanisms of an illness. It is a key goal for neuroscientists confronting mental illnesses for which available treatments remain inadequate or nonexistent. In light of these aspirations and in the context of the nation’s current funding uncertainties, neuroscientist Carol A. Tamminga, M.D., a member of the Brain & Behavior Research Foundation Scientific Council, finds herself caught between optimism and concern.

“I believe we’re really on the brink of being able to take the fabulous discoveries of neuroscience and apply them to the treatment of diseases,” she says. “Our basic knowledge of the brain and how it works is growing by leaps and bounds, and opportunities for advancing our under-standing of mental illness have never been better. But I worry about a precipitous loss of federal funding. I fear that psychiatry is one of the fields most vulnerable to cutbacks.” She also worries about an either-or mentality regarding the allotment of resources for research and treatment development versus care of the mentally ill. “The two should be paired, not opposed, and we simply have to find a way to be able to do both.”

Conceptual advances move research forward
Dr. Tamminga is chief of translational research in schizophrenia and head of the department of psychiatry at the University of  Texas Southwestern Medical Center at Dallas, where she holds the Communities Foundation of  Texas Chair in Brain Science.
 A major thrust of translational research in neuroscience now, she says, is toward “conceptual advances,” approaches that go beyond simply trying to modify or improve existing modes of treatment.

Most existing treatments for mental illnesses, including antipsychotic and antidepressant drugs, target neurotransmitters, such as dopamine and serotonin that relay information between nerve cells across the synapses in the brain.

“These days our focus is moving to what happens after neurotransmission, to postsynaptic cell signaling and the relationship of those signaling systems to the functions of neuronal populations and, in turn, to the alterations in those functions that occur in psychiatric illness,” Dr. Tamminga says. “As we learn more about neuronal population effects, we’ll be able to close in on which particular effects are associated with which symptoms, and how we can modify those effects to relieve the symptoms.”

She compares the progression she is projecting for psychiatry to the way recent advances in cardiology developed, in which, on the way to ultimate answers, improved understanding has led to new treatments that have dramatically improved survival rates. “For example if you have congestive heart failure, what you want to do is stimulate the heart muscle,” she says. “There may be hundreds of reasons why one gets heart failure, but once it happens, the question is how to modify activity back toward normal function. That doesn’t mean we take our eyes off trying to understand the causes of illness, or how to prevent illness, but in the meantime, with regard to psychiatry, if we can define the alterations in the activity in the brain, we can influence that activity to treat the behaviors associated with illness.”

One of the novel approaches Dr. Tamminga points to as promising centers on the possibility of exploiting neuroplasticity, which is the brain’s ability to change in response to environmental stimuli and form new neuronal connections. “We haven’t yet learned enough to harness this plasticity to change symptoms of mental illness,” she says, “but I believe that it will probably require an approach combining medication with brain exercises, or what we might call cognitive remediation.”

Funding creative research is key
Creative, novel approaches are what Dr. Tamminga looks for each year as she helps to screen the hundreds of applications for NARSAD Grants, which she’s been doing since 1994. “We’ve never wanted to fund the same old thing, or projects for which other funding is readily available. We like areas that may be risky, but if they succeed might bring real change as has often happened with research initiated with NARSAD Grant support.” She, herself, is a current recipient of a Distinguished Investigator award with which her lab is exploring what she says is a “highly speculative model of psychosis.”

Throughout her years of association, and particularly at the present moment of uncertain funding, Dr. Tamminga has been a strong advocate for Brain & Behavior Research Foundation. Beyond its critical grant awarding role, she is inspired, she says, by the families coping with mental illness who give it their time, energy and money,  “beginning, of course, with Steve and Connie Lieber and their ceaseless efforts in support of scientific discovery.

“The Brain & Behavior Research Foundation funds people who are creative, people who bring in new methodologies and points of view,” Dr. Tamminga says. And while concerned about the precarious state of federal funding, she remains optimistic. “There’s so much momentum in basic science research now that will continue because it’s so interesting, really on the verge of getting very good and very exciting.” In her view the combination of sufficient funding and a new generation of researchers “asking the right questions” are what will bring us to a new place in scientific discovery.