Why Psychiatry Is Finally Breaking Free From Dopamine
April 15, 2026
In this episode of Power to the Patients, host Brandon Li sits down with Ken Kramer, PhD, Vice President and Head of Neuropsychiatry Medical Affairs at Bristol Myers Squibb, to explore why psychiatry has lagged behind other therapeutic areas and what’s finally changing. Kramer explains how decades of reliance on dopamine-based antipsychotics shaped treatment, and why new mechanisms like muscarinic agonism are opening the door to safer, more effective options for patients with schizophrenia.
Psychiatry has long been considered one of the most complex and least understood areas of medicine. While other therapeutic fields have advanced rapidly with clear biomarkers and objective endpoints, mental health has remained rooted in subjective assessments and decades-old treatment approaches.
In this episode, Brandon Li speaks with Ken Kramer, PhD, Vice President and Head of Neuropsychiatry Medical Affairs at Bristol Myers Squibb, about why psychiatry has historically lagged behind and why the field is now entering a new phase of innovation.
Kramer explains how schizophrenia treatment has relied on dopamine receptor-blocking antipsychotics for over 70 years, often forcing patients to trade symptom relief for serious tolerability and safety challenges. He walks through how a new class of treatments, targeting muscarinic acetylcholine receptors, represents a fundamentally different approach, one that may reduce these trade-offs while addressing a broader range of symptoms.
The conversation also explores the structural challenges that have made psychiatric drug development so difficult, from subjective clinical endpoints and high placebo responses to the lack of reliable biomarkers. These barriers pushed many large pharmaceutical companies out of psychiatry for decades.
Now, that trend is reversing. With better scientific understanding, improved trial design, and new mechanisms of action, pharma is re-entering the space with renewed confidence.
Brandon and Ken also discuss the real-world challenges of launching novel treatments, including clinical inertia, physician adoption, and the importance of medical affairs in bridging the gap between approval and actual patient impact.
This episode covers where psychiatry has been, what’s changing, and what it will take to deliver better outcomes for patients living with serious mental illness.
What You’ll Learn:
- Why psychiatry has lagged behind other therapeutic areas in innovation
- How dopamine-based antipsychotics shaped schizophrenia treatment for decades
- The trade-offs patients face with current standard-of-care therapies
- How muscarinic receptor-targeting drugs offer a new approach
- Why psychiatric clinical trials are uniquely difficult to design and execute
- How subjective endpoints and placebo effects impact drug development
- Why pharma companies exited psychiatry and why they’re returning now
- The role of medical affairs in driving the adoption of new treatments
- How clinical inertia affects real-world patient outcomes
About the Guest:
Ken Kramer has a PhD and Vice President and Head of Neuropsychiatry Medical Affairs at Bristol Myers Squibb. He has spent his entire career focused on psychiatry and neuroscience, with a deep commitment to advancing treatment options for serious mental illness and addressing the stigma associated with these conditions. At BMS, he leads efforts to translate scientific innovation into real-world patient impact across neuropsychiatric disorders.
Episode Resources: