Developments in Clinical Psychopharmacology From 2000 Through 2026: A Personal Perspective

The first column in this 2-part series covered the history of clinical psychopharmacology from the author's perspective from 1975 to 2000. This column covers the last 26 years of clinical psychopharmacology as experienced by the author from 2000 to 2026. It focuses on the following major areas: (1) system-level neurobiology of neuropsychiatric drugs with an early focus on antidepressants; (2) circuit-based drug discovery; (3) pharmacokinetic, pharmacodynamic, and metabolic determination of psychotropic drug response as encompassed by Preskorn's Organizing Equation; (4) therapeutic drug monitoring (TDM) and pharmacology safety based on the use of TDM's ability to measure the functional as opposed to just the genetic capability of a patient to metabolize a medication; (5) enzyme-mediated drug-drug interactions; (6) multiple medication use in everyday clinical practice; (7) the results and implications of the results of the NIMH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study; and (8) early phase clinical investigation of novel central nervous system mechanisms. The column illustrates the author's goal to bring science to the practice of psychiatry, beginning in the mid-1970s, when psychoanalysis dominated psychiatric thinking, up through 2026, within our current limits of understanding. It also illustrates how, at least for one psychiatrist, knowledge in our field has evolved and his reason for having this goal.