// NATURE NEWS — SPAZIO & SCIENZA
How personalization and psychedelics are revitalizing psychiatry
Psychedelic-therapy clinics such as this one need to be accessible to all.Credit: Cole Burston/AFP/Getty
More than one billion people globally live with a mental-health condition. Collectively, these disorders are now the world’s leading cause of disability. Depression and anxiety alone cost the global economy an estimated US$1 trillion every year.
The grand plan to transform psychiatry — by personalizing mental-health care
Conventional pharmacological approaches to improving mental health are falling short. However, two Nature News features this week report on innovations that indicate a shift is under way. One describes the personalization of psychiatric care; the other discusses developments in psychedelic medicine. Although neither effort will provide a complete solution for the mental-health crisis, both are bringing much-needed ingenuity to the field.
To ensure that these ideas translate into improvements in mental-health care, they must be pursued with rigour and in a way that ensures they have the widest possible reach. As psychedelic-development programmes move towards regulatory approval, the US Food and Drug Administration has rightly clarified what types of evidence and outcome it expects to see in trials (see go.nature.com/4bstrh2). Funders and regulators must now ensure that approaches that prove successful actually reach the people who need them. This will not be straightforward because many psychedelics and proposed personalized treatments are expensive. They are developed with small groups of people with a specific condition in mind and therefore do not benefit from economies of scale. At the same time, personalized treatments can be out of reach for people from low-income backgrounds, who are more likely than others to have a mental-health condition.
Why pharma firms are betting billions on psychedelic drugs despite setbacks
Under the current psychiatric model for mental-health conditions, two people with the same diagnosis of depression can have distinct symptoms, different underlying biology and divergent responses to the same treatments. That heterogeneity is reflected in clinical outcomes. A substantial proportion of people don’t respond to the first antidepressant drug that they try, and around 30% remain symptomatic after trying several treatments (C. Njenga et al. BMJ 386, e073823; 2024).
In practice, conditions are more complex than conventional diagnostic categories suggest. One reason for this is that classifications have relied on subjective reporting of symptoms. Now, precision psychiatry approaches aim to improve diagnosis and outcomes. The idea is to personalize treatments by cataloguing symptoms in detail and as objectively as possible, and identifying measurable biological indicators, or biomarkers. The expectation is that this can help to match people with more-effective treatments, and do so faster by shortening the process.
Methods include the use of genetic and blood-based biomarkers; measures of brain activity such as functional magnetic resonance imaging and electroencephalograms; and ‘digital phenotyping’, in which smartphones and other sensors record sleep and movement, for instance. But these assessments have yet to consistently yield improvements for people with mental-health conditions, as one of the features reports. Some researchers say that another approach would be to gather as much data as possible on how people respond to specific treatments and which responses correlate with mental-health improvements. Those data can then be fed into artificial-intelligence models to predict how individuals might fare. It is unclear, however, whether the benefits of such tools would outweigh their costs.
As reported in the other feature, psychedelics might tap into the brain’s capacity to reorganize its connections and circuits, potentially disrupting rigid patterns and enabling psychological changes — even for some people for whom conventional treatments haven’t worked.