New Breakthrough in Precision Psychiatry Helps with Accurate Diagnoses and Personalized Treatments for Mood Disorders

According to the National Institute of Mental Health (NIMH), one in five people will have a clinical mood disorder at some point in their lifetime. Unfortunately, existing practices for diagnosis are imprecise.

“There are currently no routinely used objective ways to diagnose mood disorders like depression and bipolar disorders,” said Alexander B. Niculescu, MD, PhD — a professor of Psychiatry and director of the Center for Precise, Personalized and Preventive Psychiatry (C4p) at the University of Arizona College of Medicine – Phoenix. “Matching people to treatments is often a trial-and-error process.”

As a result, some patients are misdiagnosed, making the medications ineffective or leading to side-effects and adverse life outcomes: misery, lack of productivity and, in some tragic cases, suicide.

To combat this, Dr. Niculescu has been investigating blood biomarker testing to determine the precise care needed to treat each patient.

The study, recently published in the high impact Springer Nature top specialty journal Molecular Psychiatry, sought to address specific gaps in psychiatric care with an active goal of transforming the diagnosis and treatment field of mood disorders.

Through expanding the work of his previous research in blood biomarkers, Dr. Niculescu and his team have been able to accurately identify mood disorders and proper therapeutic treatments for patients; and he proposes that this multi-year effort will help revolutionize the field in a three-fold process: understanding, diagnostics and therapeutics.

“We now understand that the biology of mood disorders may be related to cell growth versus apoptosis, literally life and death,” Dr. Niculescu said.

Dr. Niculescu and his team — which included Joey Balducci, Edie Gobel, Michael Schmitz, Julia French, Ashlyn Germanos, Sarah Corey, Rowan Bhagar, Sunil Kurian, PhD, Anantha Shekhar, MD, PhD, and Helen Le-Niculescu, PhD — studied 569 patients, some over the course of nearly two decades, who had a clinical diagnosis of depression or bipolar disorders.

The study looked at two diametrical phenotypes, low mood/depression and high mood/mania, and carried out analyses in multiple independent cohorts,

The findings showed that, in about half of the patients, biomarker testing revealed a different conclusion than what was clinically diagnosed. For example, the clinical diagnosis was of depression, but the biomarkers indicated a bipolar disorder.

“Those patients did more poorly than patients whose biomarker testing and clinical diagnosis agreed,” Dr. Niculescu said. “They did poorly on their clinically prescribed antidepressant treatments, had more hospitalizations for mood episodes and for suicidality, and our biomarker testing showed they would have been a better match to a different group of medications called mood stabilizers, often used to treat bipolar disorder.”

Through the experiment, their analyses suggest that usage of the biomarkers can create better medication matches, lessening the odds that a full-blown clinical episode manifests. Prevention can be accomplished with biological interventions, lifestyle changes or psychological therapies.

Pharmacogenomics showed that omega-3 fatty acids, lithium and vortioxetine were good matches for treating clinical depression. For bipolar depression, lithium, valproate and clozapine were shown as good clinical matches for treatment.

“There needs to be more widespread use of low doses of lithium, even perhaps as an over-the-counter nutraceutical in mild cases for prevention,” Dr. Niculescu said.

Having a critical distinction of diagnoses through blood biomarkers will allow patients to receive proper treatment based on their specific needs and also can result in highly personalized medication matches. Precision psychiatry approaches would help patients, families and physicians. Patients can get properly diagnosed and physicians can make medication choices that are effectively tailored to the individual.

“Science and medicine are never definitive and should not be dogmatic,” Dr. Niculescu said. “They move forward as data and facts accumulate.”