Institute For The Future

A Future of Personalized Depression Treatment

Health Horizons researchers will be attending the 2014 Personalized Medicine World Conference here in Silicon Valley, January 27-28. In the run-up to the conference, we’ll be talking with some of the scheduled speakers to preview their talks at the event.

Our first in the series of pre-conference conversations was with Amit Etkin, MD, PhD, an Assistant Professor of Psychiatry and Behavioral Sciences at Stanford University, and an Investigator in the VA Sierra-Pacific Mental Illness Research Education and Clinical Center (MIRECC) at the Palo Alto VA. The overarching aim of the Etkin Lab is “to understand the neural basis of emotional disorders and their treatment, and to leverage this knowledge to develop novel treatment interventions.”

I was drawn to Dr. Etkin’s work as an interesting signal of a forecast called Measuring the Subjective from our 2010 Health Horizons map on the Future of Science, Technology, and Well-being. We forecasted:

“New ways of reliably measuring subjective states such as happiness, anxiety, or pain, and finding the neural correlates of personality and behavioral patterns will help us better understand our own capacities, potentials, and vulnerabilities in relation to other people.” 

Dr. Etkin’s lab is doing just that by using “advanced technologies to investigate neural pathways in both healthy participants and patients suffering from anxiety, depression and post-traumatic stress disorder.” At PMWC he will be presenting the first analysis of an international study – the first of its scope and size – to predict optimized treatment in depression.

The study included three different arms of randomized medications with 1,000 depressed individuals. Participants took a battery of tests to probe a variety of brain functions, such as ability to pay attention, inhibit distractions, or identify emotions. They then used that objective, computerized information to learn something about which medication the patient should receive – and were able to predict with some accuracy who would respond best to which medication.

This study builds on ongoing research in the Etkin Lab about how brain circuits underlie behavior and is part of a larger move in the past few years to act with urgency to map and understand the complex circuitry of the brain. This will move mental health away from the current model of “symptom-based diagnosis.” Dr. Etkin referenced a recent quote from Tom Insel, the director of the National Institute of Mental Health:

“Symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”

Dr. Etkin is working toward a future where we fully understand individual brain circuitry and can develop novel treatments based on the underlying problems, not just the symptoms.

The future of computation in health often turns to a conversation of abundant data. We are moving into a world where everything is measured and digitized, from our phone and email correspondence to our activity levels and environmental surroundings. While these measurement hold great promise for understanding how someone is responding to depression treatment, for example by noticing changes in physical activity or social engagement, they are not currently able to predict or guide treatment. Eventually, our ability to accurately measure once-subjective experiences will transform the practice of mental health and enable more personalized and effective treatments. 

Dr. Amit Etkin’s talk, Performance on Cognitive and Emotional Tests Predicts Treatment Response in Depression, is on the first day’s main track at 2:15 p.m.