Precision psychiatry: towards personalised treatment

For decades, choosing a psychiatric treatment has been a combination of clinical knowledge, experience and, sometimes, trial and error. Two people with the same diagnosis could respond very differently to the same intervention, without the doctor being able to predict with certainty which approach would work.

Precision psychiatry aims to change that. Inspired by precision oncology (where treatments are increasingly personalised according to the genetic profile of the tumour), it tries to use individual data to choose the most suitable intervention for each patient.

What it is based on

The main lines of research:

Biomarkers. Researchers around the world are looking for biological markers (in the blood, through neuroimaging, through analysis of cerebrospinal fluid) that could predict response to treatment. Although no biomarker is yet robust enough for routine clinical use, the progress is significant.

Genetics. Pharmacogenomic studies look at how individual genetic variants influence the way certain substances are metabolised. In some clinical situations, genetic testing can help avoid adverse reactions or identify treatments that have a better chance of success.

Neuroimaging. Functional MRI and other imaging techniques are providing more and more information about the brain circuits involved in different disorders. In the future, this information could guide the choice of intervention.

Artificial intelligence and machine learning. Algorithms trained on data from many patients (which treatment they received and how they responded) find patterns that a single doctor cannot see. A few experimental systems are already showing promising results in predicting response to treatment.

Why it matters

For patients, this development means that, gradually, choosing a treatment will be less and less “trial and error” and more and more a decision informed by individual data. For us as clinicians, it means a steady enrichment of the tools at our disposal.

What it means for patients today

For now, precision psychiatry is still largely a research field. In current clinical practice, treatment decisions remain guided by clinical assessment, the patient’s history and the principles of evidence-based medicine.

What has already changed:

• in a few specific contexts (for example, treatment-resistant depression), pharmacogenomic testing can inform treatment decisions;
• close monitoring of the initial response to treatment allows faster adjustments than in the past;
• integrated approaches (combining psychiatric, psychological and lifestyle assessment) are becoming standard.

If you have already tried several treatments without the result you hoped for, tell your doctor: your treatment can be reviewed and adjusted.

See also: Psychiatry