Precision Medicine in Psychiatry

In 2015, the Obama Administration launched the Precision Medicine Initiative, a major research effort aimed at changing the way we treat disease and improving health. Precision medicine tailors treatment to individual patients based on a variety of information, including genetic information. It is often described as the ability to provide the right treatment to the right person at the right time.

Much of the precision medicine work to date has been in cancer treatment. But work is also underway to use precision medicine in other areas, including the treatment of mental disorders.

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Today, accurate biological tests for most mental disorders are not available, and a single approach does not work for everyone. Each person’s unique genetic, physical, mental, experience, lifestyle and other factors contribute to their response to specific treatments. By taking information on these various factors together, doctors will be able to better predict which treatment will work for which individual. There is emerging research out there to help doctors do just that.

For example, new imaging technologies allow researchers to see the brain at work, and to look at differences in how an individual’s brain is functioning and use those differences to predict what treatments may work best.

Former National Institute of Mental Health Director Thomas Insel, M.D., in a 2015 Director’s Blog, noted that precision medicine for mental disorders will likely “not come from a single genomic glitch. Rather, like many other areas of medicine, many genes each contribute only a small amount of vulnerability as part of an overall risk profile that includes life experiences, neurodevelopment, and social and cultural factors.” Information will come from many sources, including symptoms, genetic make-up, physiology, cognitive assessment, family dynamics, environmental exposures, and cultural background.

Among the research underway across the country, Mayo Clinic researchers are looking at precision medicine to improve depression medication treatment. Genetic differences can cause people to react differently to medication—some may respond well to a particular medication while others may experience difficult side effects. Researchers are exploring the potential of using genetic testing and electronic health records to individualize depression treatment with medications. If doctors were able to determine which medications were more likely to work for particular individuals, they could avoid the difficult process of trial and error that is often necessary today.

Stanford University has undertaken an initiative looking at mental health and prevention of premature mortality. People with serious mental illness on average die a decade or more earlier than people without mental illness. Researchers are working to identify at-risk individuals and families and to develop interventions to preempt and prevent problems. They will focus on several areas including suicide, disorders that co-occur with mental illness, grief and survivorship, and the social and economic consequences of mental illnesses.

Columbia University researchers are focusing precision medicine efforts on several conditions that are strongly genetic—autism, schizophrenia, and obsessive-compulsive disorder. Jeffrey Lieberman, M.D., Chair of Psychiatry at Columbia and former APA President, noted in a panel discussion in 2015 that precision medicine in psychiatry offers a “much more precise way of diagnosing and a much more efficient way of determining what treatment patients should receive.”

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