The effects of trauma can be debilitating, reshaping lives and livelihoods – for those directly exposed as well as others around them. It can result in intolerable symptoms including shame, numbing and an inability to establish trusted relationships, as well as impacting our immune systems and physical health more broadly.
Once understood to be the preserve of those who have suffered through violent conflict and war, there’s now a growing acknowledgement of the prevalence of PTSD and trauma as a result of physical violence in the home, abuse, neglect and addiction. Addressing trauma is rightly and increasingly recognised a critical social and public policy priority.
Advances in neuroscience are today giving us new tools to better understand and treat conditions like PTSD. Until now the treatment of complex mental health conditions has been subject to two main challenges.
First, interventions that improve mental health have been poorly targeted. Our limited understanding of the molecular causes of conditions like depression, PTSD and addiction mean clinicians are forced to use subjective and self-reported measures to diagnose and assess the efficacy of a treatment.
This means that the standard of care is often inadequate – patients often try one treatment for weeks or months, only to find that it doesn’t work. This leads many to suffer from the debilitating impact of ill-health on their work and broader quality of life. This problem is particularly acute for those suffering from complex conditions like PTSD and others for whom psychotherapy and selective serotonin reuptake inhibitors (SSRIs) have proven ineffective.
Next, there is a lack of reliable data on how individuals respond to specific treatments. The measurement of diagnostic symptoms is not widespread in psychiatry and mental health meaning that, unlike in many other areas of healthcare, clinicians have limited data on which to base prescriptions.
All of this adds up to a situation in which clinicians are throwing a dart while blindfolded and hoping it hits the right diagnostic spot.
Yet there are a range of new technologies and therapies that show signs of revolutionising treatment.
Precision psychiatry is emerging as a way to bypass the “one-size-fits-all” approach to mental healthcare. By establishing measurable diagnostic symptoms and using brain imaging and analysis technology alongside AI, mental health professionals are now able to create a unique neurobiological profile before beginning treatment. This means they are better able to identify the treatments with the greatest likelihood of success based on individual characteristics. In doing so, they can take the guesswork out of mental health.
While new technologies are coming to the fore in our efforts to address mental health, new therapies and substances are also being increasingly integrated into precision techniques. For example, the use of psychedelics in precision-based approaches is emerging as a promising frontier. Psychedelics – which, when used in an appropriate environment under professional supervision, are generally safe and not addictive – have been shown to rewire the brain, often addressing the root causes of mental illness, not just the symptoms.
Psychedelics are now in use in clinical trials internationally for a range of mental health conditions. The FDA, for example, recently approved a clinical trial in which participants will use novel at-home functional magnetic resonance imaging (fMRI) devices to track what happens to their brains when they take a therapeutic dose of ketamine. Eventually, research of this nature will help physicians better understand how psychedelics work so they could, potentially, prescribe them with more accuracy. With the use of MDMA for PTSD and psilocybin for depression likely to gain federal approval in the US in the next 20 months, these new approaches to treating mental health are closer than many might think.
The costs of brain imaging are still significant, but this is gradually reducing. At-home wearable devices may soon make brain imaging accessible for more people. Within ten years these technologies could be as ubiquitous as FitBits. This would enable each of us to measure our brain responses over time – including before and after psychedelic-assisted therapy – and give clinicians new, live data to improve the treatment and diagnosis of mental health conditions.
While regulatory agencies continue to assess the data from this new generation of clinical trials, precision mental health shows signs of promise and, with it, the hope of helping more people live lives without the burden of chronic ill health.
Lead Image: Getty.