Up close and personal: The potential of pre cision medicine in mental health
Personalised medicine has revolutionised treatments and kept patients at the fore, across an array of therapeutic areas. Lina Adams illuminates the applications that this has, and is continuing to have, in the field of mental healthcare
As technology has advanced exponentially over the years, the landscape of clinical practice has continually evolved to adapt to these changes. The principles of personalised medicine have always been integral to clinical practice, since the very first efforts to classify disorders, and to prescribe a specific treatment on the basis of a precise diagnosis.
The proliferation of this method across many therapeutic areas could allow clinicians to prevent disease at the onset, before clinical symptoms appear.
They can then select the appropriate therapy for the individual and save costs in both clinical trials and healthcare.
Personalised medicine tailors treatment to individuals based on genetic factors and clinical information. This has applications in a broad range of medical fields, such as cancer genomics, and in the diagnoses process of an array of conditions. Research has also shown that personalised medicine can be used for those with, and at risk of, heart and circulatory diseases.
There are significant applications for precision medicine in mental health, as everyone has unique biological factors that impact their neurology. Recent research has shown, in particular, promise in mapping the genetics of clinical depression and major depressive disorder (MDD).
Pharmafocus spoke to Javier Garcia Palacios, PhD, Head of Personalised Healthcare Integrated Solutions, Roche, who shared: “Personalised healthcare means better health at a lower cost for people and society, by shifting from a one-size-fits-all approach to the best care for each person. With personalised medicines, treatments target the underlying biology of a disease and advanced diagnostics help doctors find the right treatment for the right patient.
“Personalised healthcare more broadly is a holistic approach to healthcare that aims to integrate the components of care (prevention, diagnosis, treatment, monitoring) into a seamless experience that helps people achieve optimal outcomes while reducing complexity and costs.”
Recent research has shown promise in mapping the genetics of clinical depression.
According to Ness Labs: “The China Oxford and VCU Experimental Research on Genetic Epidemiology study analysed the cases of more than 5,000 women suffering from major depressive disorder (MDD) and used low coverage sequencing to genotype both these women and a control group of equivalent size; they identified two genome-wide significant loci contributing to the risk of MDD, one near the SIRT1 gene, and the other in an intron of the LHPP gene.”
This study is encouraging, as the results suggest that low sequence coverage of a large number of individuals can be an effective way to infer genetic signals, supporting research that depression is largely genetic.
Javier added: “Using advances in data, analytics and technology, a personalised approach to healthcare has the potential to provide a more precise, evidence-based, holistic care tailored to each individual, helping patients achieve better outcomes throughout their lives. At Roche, we leverage advancing and emerging digital technologies to enable more personalised care, and aim to be transversal to mental health across disease areas. For example, anxiety and depression are common among people with chronic diseases, with the prevalence of depression during cancer treatment being approximately 14%. Therefore, having a holistic, personalised approach for oncology patients, including mental health, can lead to better outcomes overall.
“Additionally, with a strong need for resilience in facing chronic diseases, we see the impact positive mental health, including appropriate stress and sleep management, can have on therapy adherence and compliant behaviours. Many apps focus uniquely on mental health, and we now see them expanding to encompass mental health through chronic disease management.”
Personalised medicine for mental health can also come in the form of virtual therapy platforms. In recent years, many apps have come to the forefront of digital health to personalise care for each individual and ensure that each patient’s needs are being met. Smartphone apps create ease of accessibility in areas such as diagnosis, symptom tracking, and self-management. The latter, in particular, has allowed patients to access support regularly and at their fingertips.
Chronic health can inevitably take a toll on a patient’s wellbeing, due to concerns about financial costs, health anxiety, and individual circumstances. Heal is an app providing urgent care as well as mental health support, offering at-home care through telemedicine, remote appointments, and remote monitoring. Similarly, the app AmWell offers online doctor consultations and healthcare support, as well as options for therapy. These options enable clinicians to scale therapy and offer personalised support for those with mental illnesses. As new therapeutic interventions emerge, technology continues to be pivotal in the management and treatment of mental health.
Rising to the Challenge
Developing personalised medicines for mental health is not a streamlined process, and there are inevitable security concerns that need to be considered. Healthcare systems and pharma companies need to work collaboratively to ensure that data is being efficiently stored and managed.
For the May issue of
we spoke to Dr Andy Blackwell, Chief Scientific and Strategy Officer of data-driven AI healthcare company ieso, about challenges in developing smartphone apps for mental health. Dr Blackwell told us: “Digital innovation in mental health is currently transforming access to mental healthcare. However, access is not enough – there must also be a focus on quality and outcomes.
“We believe digital innovations, that engage patients and show real-world evidence of efficacy, will ultimately be industry leaders
in the future of mental health care. Further, the insights from a data-rich sector like digital therapeutics can generate will help clinicians to make more accurate diagnoses, to optimise and personalise treatment decisions ,and to eliminate unnecessary or ineffective practices.”
Javier, at Roche, also shared with Pharmafocus: “The healthcare industry generates the world’s largest volume of data, and medical knowledge doubles every few months. This creates challenges both for healthcare systems that can’t effectively and efficiently capture and deliver value from underutilised sources of data, and providers and patients navigating an overload of information. Additionally, delivering truly personalised healthcare can be challenged by the need to achieve patient trust, which is paramount to fully realising the value of data and dataenabled technologies. To earn and maintain patient trust, we must be transparent and uphold the highest standards for data privacy, de-identification, and security. It’s also essential to incorporate the patient’s perspective to design truly patient-centred, user-friendly digital tools that solve for distinct patient needs.”
Patient trust is of utmost importance when developing personalised medicines, as individuals need to know that they can trust their healthcare provider. In June, I wrote a feature in which I explored the rising role of technology and AI in data management. Electronic Data Capture (EDC) methods, such as Bluetooth or similar technology, as accurate data can be obtained directly from the patient, increasing patient convenience through allowing real-time data to be synced into the clinical database. It is important to mitigate security concerns when managing and storing data from participants in trials. This can be done through using reputable cloud service providers to offer continuous security monitoring and incident response, as they can quickly identify security issues and can apply patches.
If healthcare providers can work in conjunction with pharma companies to mitigate cybersecurity concerns, they can significantly increase patient trust and therefore keep the patient’s needs at the core of treatment.
Personalised medicine still has plenty of room for application in mental health, but due to the complexities of the brain and the pathophysiology of its disorders, this is no easy feat. Each patient’s neural networks are different, and what works for one individual may have little effect on another.3 Research needs to advance in order to enhance the clinical management of mental illnesses, especially in high-risk and complex patient populations, such as women with children under 12 months, and in the elderly.
Biomarker development and precision medicine interventions need to be integrated, to enhance patient outcomes. These biomarkers can help in detecting suicidal tendencies, sometimes reaching about 95% accuracy.
Whilst there is currently limited evidence supporting biomarkers in mental health research, there is still ongoing research to support their role in identifying disease subtypes, with the end goal of enhancing prevention and diagnosis. The future of precision medicine in mental healthcare, and beyond, is certainly looking promising.
Visit: Nurnberger, J. I. (2017). A Genetic Locus Associated With Depression: The Iceberg Begins to Melt. Biological psychiatry, 82(5), 304-305.
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