Big Pharma walked away from mental health years ago. Now, some companies are starting to come back. Back in the 1990s, antidepressants like Prozac and Zoloft made huge waves. Sales were high. Awareness was growing. But instead of building on that momentum, many drug giants quietly stepped back.
Mental health research dried up while other areas like cancer and autoimmune diseases took center stage.
That retreat was not because people stopped needing help. Over 50 million Americans live with mental illness. And for too many, today’s treatments don’t work well or come with side effects that make life harder. So why did Big Pharma leave in the first place?
The Mental Health Maze is Hard to Crack
Big Pharma walked away from mental health because the science is messy. With diseases like cancer, you can run a test and see a tumor. You can target a gene. But mental illness? That is a different beast.
Everything depends on what patients say they are feeling. That makes it harder to measure progress in drug trials – and harder to prove a drug actually works.
This uncertainty scared off many drugmakers. And those who stayed got burned more than once. Just last week, Johnson & Johnson dropped a new depression drug after it flopped in trials. Same story with AbbVie, whose big schizophrenia drug missed the mark in a key study last year.
The Risks are High, but So are the Rewards
Even with the setbacks, there is money – and impact – to be made. J&J’s Spravato, a nasal spray based on ketamine, made $1 billion last year. It is helping people who don’t respond to traditional antidepressants. That kind of success is hard to ignore.
Big Pharma is slowly creeping back. In late 2023, Bristol Myers Squibb paid $14 billion for Karuna Therapeutics. Why? Because Karuna built something rare – a new way to treat schizophrenia without the miserable side effects of older meds. Johnson & Johnson also dropped $15 billion to scoop up Intra-Cellular Therapies, betting big on a pill for bipolar depression.
Old Drugs, New Tricks
Most of today’s psychiatric drugs are updates of stuff discovered decades ago. Thorazine – the grandfather of all antipsychotics – was found by accident in the 1950s. It worked by blocking dopamine in the brain. Almost everything since then has followed that same path.
Karuna’s approach is a good example. They took an old Eli Lilly drug that had potential but nasty stomach side effects. Then they combined it with another chemical to cancel out those issues. The result? Cobenfy – a treatment that could change how we handle schizophrenia.
The Biotech Underdogs are Leading the Charge
Big Pharma walked away from mental health, but small biotech companies kept going. While the giants paused, startups filled the gap.
Companies like Compass Pathways and Cybin are studying psychedelics like MDMA and psilocybin. These drugs are not fully understood yet, but early results are promising – especially for PTSD, anxiety, and depression. They are still on the fringe, but the interest is growing.
Meanwhile, venture capital has poured more than $5 billion into mental health biotechs over the last ten years. Investors are betting that the next big discovery won’t come from a mega-corporation. But from a small, scrappy team willing to take risks.