Every year, around 100,000 people in the U.S. experience psychosis—a serious mental health condition that can deeply disrupt how they think, feel, and understand the world.
It can cause people to see or hear things that aren’t there, feel confused, or lose touch with reality.
Just over a year ago, the first new drug for schizophrenia in nearly 50 years was approved. Now, scientists are starting to see how it works in real-world settings.
A new study published in Nature Mental Health gives early insight into how different patients respond to this new medication and what that might mean for future treatments.
The study was led by Michael Halassa, a professor of neuroscience at Tufts University School of Medicine. His team looked at the medical records of 49 patients who had been hospitalized with conditions like schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic symptoms.
All of these patients had not seen enough improvement with standard antipsychotic drugs, so doctors added the new drug—called Cobenfy—to their treatment plans. Cobenfy is a combination of two ingredients: xanomeline and trospium chloride.
What makes this drug different is that it doesn’t work the same way as traditional antipsychotics. Most older drugs block dopamine receptors in the brain, but Cobenfy targets different parts of the nervous system.
Earlier clinical trials had shown that the drug could work better than a placebo, but researchers wanted to see how it performed in real medical practice.
Halassa’s team used statistics to look for patterns in how the patients responded. They found that some people showed big improvements with the new drug, while others didn’t benefit much at all.
The patients who improved the most were those with “negative symptoms.” These are symptoms like being socially withdrawn, lacking motivation, or talking very little.
After taking the new drug, these patients became more social and had a brighter mood. People who had used stimulant drugs in the past also seemed to benefit more from Cobenfy.
On the other hand, the drug didn’t help much for people who showed aggressive behavior or had manic symptoms like those seen in bipolar disorder. It also didn’t seem to work well for patients with intellectual disabilities, although there were only a few of these patients in the study, so this result is still uncertain.
Some people with hallucinations—like hearing voices—did improve, but not as strongly or consistently as those with negative symptoms.
This study gives support to the idea that schizophrenia and related disorders are not just one single illness. Instead, they may be made up of different subgroups that each respond to treatment in different ways. That’s why one drug might help one person a lot but not work for someone else.
Dr. Halassa hopes this research is a step toward “precision psychiatry”—a future where doctors can tailor mental health treatments to each person, much like cancer treatments are chosen based on a patient’s specific condition.
To get there, scientists will need to do more studies that test how people with specific symptoms or brain features respond to different medications.
The goal is to stop the long and painful process many families face—trying one medication after another, often for years, before finding something that helps. By paying close attention to which symptoms improve with which drug, doctors might someday predict what treatment will work best from the start.
“If we start treating every symptom response and non-response as valuable data,” Halassa says, “we could save individuals and families years of trial and error in finding effective treatment.”
If you care about mental health, please read studies about how dairy foods may influence depression risk, and 6 foods you can eat to improve mental health.
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The study is published in Nature Mental Health.
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