Precision Mental Health: Biotypes, Brain Imaging, and Personalised Treatments

Precision mental health aims to tailor treatment from the outset by combining brain imaging, digital assessments, and large-scale data. In this episode, Dr. Zachary Cohen and Dr. Leeanne Williams discuss how brain network patterns or biotypes may predict who benefits from which therapies, how data from smartphones and wearables could inform care, and the practical steps and challenges of bringing these advances into everyday clinical practice, including privacy concerns and system redesign.

What is precision mental health and why it matters

Precision mental health is about understanding the root causes of someone's struggles beyond the surface symptoms and using objective tests to guide treatment decisions. The guests explain that, unlike traditional trial and error approaches, this field seeks to identify specific brain circuit disruptions and leverage data to match patients with therapies most likely to help them, expediting recovery and improving outcomes. "precision mental health really comes down to understanding why someone's struggling" - Dr. Zachary Cohen, Assistant Professor of Psychology.

Advances enabling personalized care

The conversation highlights advances in data science, brain imaging with functional MRI, and the mapping of functional networks that orchestrate emotion, thought, and behavior. Williams describes a process to quantify individual brain disruption patterns, which she calls biotypes, and Cohen explains how digital phenotypes derived from smartphones and wearables can provide context for these neural patterns. "aggregating data from thousands of trials allows us to uncover patterns of response" - Dr. Leeanne Williams.

From lab to clinic: how it could work in practice

Williams discusses workflows to integrate brain scans into clinical care, including referral systems and an image processing workflow designed for real-world clinics. Cohen notes that digital therapeutics and scalable data-driven interventions could make precision care accessible beyond academic centers, while both acknowledge the need for interoperability with electronic health records and reimbursement pathways. "we've been building the workflow so they could be implemented in clinical settings, not just in research centers" - Dr. Leeanne Williams.

Biotypes of depression and anxiety and treatment matching

In a detailed section, Williams outlines six brain circuit biotypes that account for most of the variability in depression and anxiety. Each biotype aligns with specific treatment responses to medications, psychotherapy, neuromodulation, or novel therapies, enabling clinicians to move away from a one-size-fits-all approach. The researchers share that using biotypes to guide treatment can markedly improve outcomes for many patients. "we found 6 biotypes that account for 90% of the variability" - Dr. Leeanne Williams.

Barriers, ethics, and patient perspectives

The discussion delves into system-wide challenges, such as clinicians' readiness to adopt data-driven recommendations, harmonizing measures with routine care, and regulatory considerations. The speakers emphasize transparency, avoiding black box decisions, and engaging patients who increasingly seek cutting-edge options online. Cohen raises concerns about data privacy and potential misuse of predictive information by insurers or employers, underscoring the need for safeguards. "this is something that scares me because it could be misused if not protected" - Dr. Zachary Cohen.

Future directions: large-scale, transdiagnostic, and preventative goals

Looking ahead, the researchers describe ambitious plans for Framingham-like, national-scale studies to compare treatments across conditions and follow patients over time to assess short-term and long-term impact. Williams notes NIH Impact MH funding as a catalyst, while Cohen discusses expanding access to underserved communities through data-informed, personalized care. "Framingham for mental health" - Dr. Leeanne Williams.