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The grand plan to transform psychiatry — by personalizing mental-health care
David Adam is a science journalist based near London.
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You go to see a psychiatrist a decade from now. Alongside the usual questions about how you’re feeling, your work and your relationships, they look at biometric data from your phone about your sleep and speech patterns, examine the results of a blood test or a brain scan and even check your postcode to see whether your neighbourhood has high levels of pollution. An algorithm then compares that information with data from thousands of other people, determines which types of treatment have worked best for people similar to you and uses its findings to suggest a treatment regime.
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That’s a vision of the future called precision psychiatry. And it’s a world away from most people’s experiences today. For all the progress that has been made across the medical sciences, psychiatry remains a frustratingly imprecise discipline. Doctors use someone’s symptoms and clinical history to make a diagnosis and prescribe treatments. But mental-health diagnoses are broad and can be vague — a particular therapy might transform one person’s life, but offer little help to someone else with apparently the same disorder.
As a result, people with mental-health conditions often find themselves cycling through treatments and doses, searching, mostly by trial and error, for one that works.
To improve things, psychiatrists want to divide broad diagnoses into more useful subgroups and match treatments to individuals using a data-driven approach. Some researchers are looking at genes and brain circuits; others are turning to data on speech, sleep or social circumstances. Psychiatrists working on The Diagnostic and Statistical Manual of Mental Disorders (DSM), the discipline’s dominant classification system, are even considering how socio-economic, cultural and environmental factors might be incorporated in the future.
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“I think precision psychiatry is certainly part of the future,” says Tom Insel, a psychiatrist and former director of the US National Institute of Mental Health (NIMH), who now co-directs several mental-health-focused companies. “We’ll be able to say from the get-go, this patient needs this treatment and that’s where they’re going to do best.”
But some clinicians say that the personalized approach has yet to prove itself. Advances in genetics, brain imaging and biomarker research for psychiatry have failed to deliver on their promise before, and studies continue to reveal just how heterogeneous many psychiatric disorders are. “Psychiatry has this model that the white knight is going to ride over the hill and solve all our problems,” says Kenneth Kendler, a psychiatric geneticist at Virginia Commonwealth University in Richmond. “And we’ve been repeatedly disappointed.”