Several NARSAD Grantees and Foundation Scientific Council Members were featured in an article titled “From the Lab to the Couch: Personalized Psychiatry in the Genomic Era” from NOVA PBS on December 4th. The article explains the need for what they are calling “personalized psychiatry”―prescribing specific psychiatric medications, therapies and treatments to patients based on their individual genetic makeup and biology. Currently, the majority of psychiatrists prescribe treatments based on population-wide statistics, not individual profiles.
“You basically have this bind―that we have very effective treatments but the problem is that it’s trial and error for any one person,” explains Helen Mayberg, M.D., Professor of Psychiatry, Neurology and Radiology at Emory University in the NOVA article. Dr. Mayberg, with the support of three NARSAD Grants (and many other sources of funding), has been working on identifying biomarkers (or biological predictors) of depression by mapping circuits in the brain using evolving methods in neuroimaging over two decades (from positron emission tomography, or PET, to functional magnetic resonance image or fMRI). In her latest research, she found evidence that identifying (via neuroimaging) a patient’s particular brain metabolism and circuitry may help predict whether a treatment for depression will be effective for them or not—whether it is medication or talk therapy. “We want to not only match a patient to a treatment that is most likely to get them well,” Dr. Mayberg said, “but we also want to know in advance that a treatment is unlikely to work.”
Other researchers are focused on identifying genetic biomarkers for mental illness. Dr. Francis Lee, a three-time NARSAD Grantee who runs a psychiatric research lab at Weill Cornell Medical College, explains in the article that when personalized genomic medicine was getting off the ground, the hope was “there would be some biomarker of some high reliability, reproducibility for psychiatric disorders... That hasn’t happened yet.” Early on he says he was expecting to link a single gene mutation to a psychiatric disorder the way gene mutations have been linked to sickle cell anemia or cystic fibrosis. “I was naïve 10 years ago,” he says. In psychiatry, it’s hard to measure how sad you are, how suicidal, or how anxious. “We’re still using self-report and psychiatric interviews for many of these types of studies,” he reports. “It’s not just going to be a be-all diagnostic marker, but it could be something that would inform what we now call pharmacogenetics,” or the use of genetic information in determining which medications to prescribe.
“We are very much at the precipice of starting to think and do these studies, but we are still early in the course of this, compared to some of our medical brethren,” says two-time NARSAD Grantee, Madhukar Trivedi, M.D., Professor and Betty Jo Hay Distinguished Chair in Mental Health at the University of Texas Southwestern Medical School. “We have 30 different depression medications, many types of psychotherapy, exercise, ECT [electroshock therapy],” he told NOVA. “No one treatment is good for everyone.” He and a team of researchers are halfway through a four-year study, in which they take blood tests and brain scans on subjects in four cities across the country, divide them up into genetic subgroups, test different medications on each, and compare the results against a placebo and each other. Dr. Trivedi concedes that there needs to be more investment in the science—using larger sample sizes—before clinicians can use blood tests, genetic profiles, or brain scans to address a complex set of behavioral and emotional factors that make up any mental illness, but he feels hopeful about how the field is developing.
Read the complete article from NOVA PBS.
Register for our January “Meet the Scientist” Webinar featuring Dr. Mayberg on Tuesday January 14th.