'Holy moly is a slow burn': Boston research center aims to revive precision psychiatry

‘Holy moly is a slow burn’: Boston research center aims to revive precision psychiatry

The science of precision medicine has made leaps and bounds over the past two decades. It helps doctors use genetics and other data to understand how to treat individual patients in a number of diseases, such as cancer and cystic fibrosis.

But one exception is mental illness.

A group of researchers based in Massachusetts hopes to change that.

Jeannine Austin suffers from anxiety and depression, and as someone who works in the health field — as a genetic counselor — she is open to a whole range of treatments.

“I’ve talked to so many people over the years who’ve been like, ‘Oh, well, you know, mindfulness meditation or whatever really works for me,'” Austin said.

So Austin, who uses these pronouns, went to a class on meditation. But with all the time sitting cross-legged, breathing deeply and marinating in their own thoughts, “basically I ended up having a panic attack,” Austin said.

Obviously, they should try another approach – maybe medication, maybe talk therapy – and it might take a while to find it.

It’s the kind of trial and error that forms the backbone of the psychiatric profession, and yet many in the field say it shouldn’t be the case anymore.

For more than a decade, the researchers continued what is called precision or personalized psychiatry.

“The foundation of precision medicine is to take advantage of individual differences in our genes, biology, lifestyle and environment to improve diagnosis, treatment and prevention,” said Dr Jordan Smoller of the Harvard University, a leader in the field.

But even Smoller said that the field of precision psychiatry is still nascent — a view shared by many others.

“I think we’re not where we are in oncology, infectious disease, maybe cardiovascular medicine,” said Dr. Tom Insel, former director of the National Institute of Mental Health and now entrepreneur. “But we are making progress.”

During a virtual conference last month, Insel said precision psychiatry could eventually help solve the current mental health crisis.

“But Holy Moly, it’s a slow burn,” Insel said. “And that doesn’t really address the urgency that so many people are feeling now, especially through the pandemic.”

As a way to jump-start research, Smoller and others launched the Precision Psychiatry Center at Massachusetts General Hospital in Boston, which sponsored the conference.

Some of the center’s work focuses on genetics, others on brain imaging, large datasets, and even some animal models.

One of the goals is to develop new drugs to treat psychiatric disorders, as the field is still using drugs that were brought to market decades ago.

But scientists say the complex nature of mental illness – including the elusiveness of clear biomarkers – has made that goal tricky.

“There are thousands of (gene) variations,” Smoller said. “There isn’t just one gene for one thing.”

Smoller said researchers have begun to identify gene combinations for major disorders like schizophrenia and bipolar disorder, but “when it comes to the prospect of clinical implementation, progress has been a bit slower”.

Scientists and pharmaceutical companies hope to develop genetic “risk scores” to help predict who will get sick as well as how an individual might react to treatment – for example, how the body metabolizes certain drugs.

Ideally, this would reduce the trial and error time spent on treatments that don’t work, avoid certain side effects and, in one of the most active areas of research, even help predict who is most at risk of attempt to commit suicide.

But clinical trials to match genetic profiles with treatment have had mixed results and have yet to yield a new class of drugs.

Some scientists point out that pharmaceutical companies may be wary of precision psychiatry because reducing the number of people who can benefit from a drug could reduce their number of customers.

“Of course, the larger the population you can treat with your drug, the greater the business opportunity,” said Cambridge-based Broad Institute scientist Dr Morgan Sheng, as well as a stakeholder at several companies. pharmaceuticals. “But … I would much rather sacrifice population size for a high level of efficiency in a smaller population.”

Sheng added, “If you have a very effective drug, you can charge more for it than a less effective drug. So you can take advantage of precision medicine, even if you have a smaller population.”

But, for now, it is still difficult to use genetic profiles to determine who will develop serious mental illness.

“The thing is, the tests we develop like this will never be completely accurate,” said Austin, who also spoke at the conference. “There are too many variables in what leads to these results, beyond just genetics.”

These variables include sleep, nutrition, social support and stress management.

Austin, who is based at the University of British Columbia, uses family history, more than genetic testing, to determine if someone has inherited a risk for mental illness. But the risk does not make the outcome inevitable.

“Could we end up in a situation where we have genetic tests that say you are more likely to benefit from this or that? Yeah, yeah, probably,” Austin said. “But should that replace other things like clinical judgment or common sense? No, maybe not. It’s something to take in a broader perspective.”

That’s what researchers at the new Boston center say they’re trying to do — research biomarkers of mental health, use artificial intelligence and mine other data to advance precision psychiatry — while acknowledging that there’s still a long way to go.


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