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How To Improve Psychiatric Treatment Outcomes with Technology & Variable Tracking

It’s blatantly obvious that psychiatry is an imperfect practice. These days people often seek the help of a psychiatrist with the belief that a pill can be prescribed to essentially cure a disease or get symptoms of a mental illness under control. While psychiatry can offer many benefits in the treatment of certain conditions, especially severe ones like schizophrenia and major depression – some people get minimal or no relief from treatment options.

Others go in for treatment and actually end up feeling even worse than prior to their first medication. This demonstrates that for some people, psychiatry can end up doing more harm than good. A select few (rare) individuals will actually reap significant benefits from long-term psychiatric treatment. In these people, they can take a medication, experience minimal side effects and feel better for years (in some cases decades).

Most people fit one or more of these descriptions:

Unfortunately there are significant problems associated with psychiatry. The first is that most treatments are not targeting the root of the problem. The medications prescribed these days essentially alter levels of neurotransmitters (e.g. serotonin) to elicit an effect. Increasing certain neurotransmitters tends to help provide symptom relief. However, this is not necessarily directly treating the root of the problem – it is essentially masking it or allowing people to function by artificially increasing neurotransmitters.

How to Improve Psychiatric Treatment Outcomes

Due to the overwhelmingly large population of individuals that get minimal or no relief from psychotropic medications, and/or those addicted to playing psychotropic roulette (constantly trying medications with the hopes that one actually “works”), there is significant need for improvement in the field of psychiatry.

While cybernetics and biotech firms are attempting to develop functional cures for certain conditions, psychiatry will remain at the forefront for providing patients with pharmacological options to “patch” symptoms of conditions. Despite the drawbacks associated with psychiatry, there are still profound ways in which the practice could be improved.

1. Determine homeostatic functioning

For each individual, the first thing that should be assessed is an individual in “homeostatic functioning.” In other words, psychiatrists should have a protocol of assessments that would be administered prior to prescribing a medication. These assessments would help offer further insight into: the condition that the person is suffering from as well as the treatments that would most likely be successful. Most importantly, it would provide homeostatic measurements to give us a better understanding of a person’s pre-treatment physiology.

Blood testing: This should not only be conducted to rule out any significant nutritional deficiencies, but a person’s thyroid should be initially checked. This will provide insight as to whether a person’s depression may be a result of poor diet and/or hypothyroidism (an underactive thyroid). Although these tests may cost some upfront money, should anything abnormal be discovered, it would save the patient significant time and hassle associated with psychotropic treatments.

  • Genetic biomarkers: There is new evidence suggesting that certain genetic biomarkers in a blood sample can indicate whether someone has depression. In other words, there may soon be a reliable blood test for depression. A person without these biomarkers would be able to determine whether they actually have clinical depression based off of the results.
  • Deficiencies: Should any nutritional deficiencies be discovered on a blood test, it may be important to address them. There is significant evidence suggesting that certain diets may increase the likelihood of depression, while other diets are better for mental health. If a person is able to address nutritional deficiencies, their mental health may improve.
  • Hormone levels: Some individuals may have abnormal levels of certain hormones that could be contributing to their depression. Having an understanding of abnormally high or low hormones could shed insight on what a person may be actually dealing with such as hypothyroidism. Additionally it will establish a reading of pre-treatment hormone levels an can be used as a comparative reference.
  • Neurotransmitter levels: There is some evidence that neurotransmitter levels can be tested. Should psychiatrists be able to get an accurate measurement of neurotransmitter levels, they may be able to determine what type of treatment would be most beneficial for the individual. Additionally this pre-treatment test would provide insight as to how certain drugs may be influencing these levels during treatment.

Brain activation: It is important to determine a person’s brain functioning prior to taking antidepressant treatments. Most obvious ways to look under the hood and actually see what’s going on involve various types of brain scans. These brain scans would help rule out rare, yet potential causes of a person’s mental illness as well as provide baseline measurements that can be used as a pre-treatment reference point.

  • EEG: This involves hooking electrodes up to a person’s head and getting measurements of their brain waves. Trained professionals are able to determine whether brain wave activity in a specific region is normal or “abnormal.” For example, if an EEG reading demonstrated too much theta wave activity in the left prefrontal cortex, neurofeedback may be recommended. If a person’s EEG looked alright, at least psychiatrists would be able to rule out a person’s brain waves as being a potential cause.
  • MRI: This is an advanced scan of the brain that is extremely thorough and can determine any structural abnormalities within the brain. This would show if there is any neurodegeneration as well as if a person had suffered from brain injuries, tumors, etc.
  • PET Scan: These are commonly used in conjunction with MRI scans. PET scans are unique in that they provide both metabolic and anatomical readings. In many cases findings on the PET can be verified by an MRI. These involve non-harmful radioactive substances to demonstrate what is occurring in the brain and results provide specific insight into the sub-type of many different mental illnesses.

Above is a talk by Dr. Amen, a pioneer in the psychiatric industry who uses PET Scans to assess and formulate treatments for patients on an individualized basis. He doesn’t simply generalize based on symptoms a patient describes, rather he takes a look at their brain activity and decides what could be done to improve it.

2. Document treatment outcomes

It is important to actually measure how certain medications are affecting people. Therefore it would be recommended to take blood measurements and brain scans “prior” to treatment, “during” treatment, and “post” treatment (several post treatment). Psychiatry currently fails in that it doesn’t know how certain people are being affected by medications. When someone says their medication is making them feel worse, it may be beneficial to know what it is specifically doing such as reducing dopamine and increasing beta waves near the occipital lobe.

  • Record “pre”, “during” and “post” treatment changes: Psychiatrists should be responsible for recording and documenting baseline (pre-treatment) measurements, “during” treatment measurements, and post-treatment measurements. This would provide insight in regards to how the brain functioning changes as a person is “treated” and how long the brain takes to recover back to (pre-treatment) “homeostatic” readings upon withdrawal.
  • Document all psychotropic medications: Astute psychiatrists currently document all medications that their patients have been prescribed in the past as well as outcomes.  Psychiatrists should continue this practice of documenting medications, supplements, dietary factors, etc.
  • Look for similarities and differences among patients: It is important to establish similarities and differences among patients such as diagnoses, effective dosages (or ranges), as well as what treatments work based on their diagnoses and physiological information (as gathered by blood tests and brain scans).
  • Realize the different sub-types of certain illnesses: This would be based on differing individual factors among people with a specific diagnosis.  By documenting various treatment outcomes, it may provide insight as to what sub-type of depression, anxiety, or ADHD a person is dealing with.  One person may have anxiety as a a result of low arousal, while another may have it as a result of high arousal – leading to different medications working based on the individual.
  • Slow titration: Many psychiatrists assume that drug companies should set the effective dosage amounts for patients.  While pharmaceutical companies do their research, there are many individual differences that their research doesn’t account for.  Some people may be more sensitive to one medication than another.  Therefore the titration process on each medication should be relatively slow, possibly documenting changes along the way of titrating up to a dose that’s effective.

By documenting the outcomes of certain treatments, psychiatrists could work with their patients to understand what certain medications are doing to their physiology.  If a person feels significantly worse, the treatment outcome would be documented along with brain scans and blood tests.  If several treatments that make a person feel significantly worse all result in specific changes in brain scans and blood tests, these changes would be noted.  When future treatments are tested, psychiatrists would know some common signs (based on scans and blood samples) that signify a person is feeling worse.

Additionally if a person feels significantly better from a treatment, this may result in changes on brain scans and blood samples as well.  These changes could be noted as being somewhat of a “template” to target with future treatments.  In other words, psychiatrists could look for how close a person is to their optimal state of functioning or “happiness.”  They wouldn’t merely be going off of subjective perception of the patient, rather they would have some objective targets to shoot for on the brain scans and blood samples (e.g. increase activity in left prefrontal region and raise acetylcholine levels in the blood).

3. Establish Commonalities, Verify Subtypes of Conditions

We know that there are specific sub-types associated with various psychiatric conditions (e.g. ADHD subtypes include the “inattentive” subtype and the “hyperactive” sub-type). Dr. Amen has already been able to document subtypes of various conditions based off of PET scans. Imagine the accuracy, overlap, and subtle individual differences that could be accounted for if further measurements and scans were taken.

As a hypothetical example, we may come to find that one type of depression that a person experiences is associated with: certain genetic biomarkers, low Vitamin B6, abnormal brain waves in the parietal lobe, and low levels of acetylcholine in blood tests. Another person may have something completely different such as abnormal brain waves in the prefrontal cortex, high acetylcholine levels in blood tests, and low Iron. Therefore these would be two individualized subtypes of a common condition “depression.”

Researchers could then set out to determine whether there are specific commonalities among people with depression; this would allow for the establishment of more specific subtypes. As more individuals would get scans and blood tests pre-treatment, during treatment, and post-treatment – cumulative scientific analysis would allow us to determine various subtypes and come up with more specific, individualized treatments that work.

Current treatment involves essentially rolling the dice or playing antidepressant roulette, hoping that something will eventually stick. The problem with this is that we don’t really know if a person is actually targeting the root of their condition. Instead they could be using an extremely untargeted treatment option that works poorly; this seems to be evident among the majority. Psychiatry lacks specificity and targeted treatments – this would address the problem.

4. Create Comparative Physiological “Checkpoints”

It would also be important to take brain scans and blood tests throughout treatment as “checkpoints.” The length of the checkpoints should be strategically determined, but it could be suggested that there be an initial checkpoint a couple weeks after a person has titrated up or gotten used to their medication. Then there could be various checkpoints every 2-3 months in which the blood tests and brain scans are conducted.

This would demonstrate changes in various levels of neurotransmitters as well as show how brain activity changes throughout the course of treatment. The brain scans and blood tests would be necessary throughout treatment to document changes as a result of tolerance and/or physiological changes from the medication. This may also give researchers more information in regards to the holistic physiological effects of these medications.

If a person is taking a medication for several months, it works well initially, but then stops working after another several months, researchers would be able to compare information from the “checkpoints” in which they took brain scans and blood tests. They would then be able to determine what changes have occurred from the medication that may have lead to increased depression.

Similarly, while medications are working, it would show researchers brain activity that represents an antidepressant response. If in self-reporting a person describes that they feel significantly happier, and certain brain activity shows up on the scans, with changes in blood levels of certain nutrients, hormones, or neurotransmitters, it may help researchers come up with new treatments. Additionally, it would provide a template that a person could consciously target in order to experience a future antidepressant effect should their medication stop working.

5. Switching medications

As I already mentioned in the article “Antidepressant Roulette,” many people switch antidepressants and get no relief from their new medications. This is because they are no longer in the same pre-drug state of functioning. Sure they may have withdrawn from their current medication prior to switching, but if the blood tests and brain scans were to be conducted, noticeable changes would be seen amongst: pre-treatment, during-treatment, and post-treatment readings.

The “post-treatment” person is essentially functioning different than they were prior to their first medication. Therefore a new medication may actually be less preferred to withdrawing as psychiatrists see the obvious depletion of certain neurotransmitters and altered brain functioning that comes about as a result of treatment. Withdrawal would then allow a person to wait until they have reached physiological homeostasis before deciding whether they wish to pursue another treatment.

The current problem associated with switching medications is that people often switch drugs hoping that one will work as well as the first one. The person doesn’t know that they are not the same person that they were prior to their first drug; their nervous system and brain is functioning differently. Therefore switching medications may be an extremely poor option unless the medications now take into account the blood test and brain scan changes.

6. Withdrawal Symptoms

Most people that end up taking antidepressants eventually decide to discontinue treatment. The reason they discontinue treatment could be due to unwanted medication side effects, the fact that the treatment isn’t working, or that they just want to be drug-free. These withdrawal symptoms typically hit people pretty hard, and can be impossible for certain people to overcome.

Upon discontinuation, psychiatrists should use brain scans as well as blood tests to find out what is happening in the nervous system. If a person’s serotonin levels significantly drop and brain wave activity shifts – it is obvious that the person is experiencing withdrawal. Many doctors are quick to assume that the symptoms a person experiences are “all in their head” or simply “reemergence of the original diagnosis.”

By taking brain scans and blood tests, we would have comparative information. A person would be able to compare themselves with how they were at a baseline (pre-treatment) as well as how they were during treatment. If a person is not experiencing the same brain activity or blood measurements as they were pre-treatment, they need to be given time and guidance to make a full recovery. Once a person has returned to homeostatic functioning, it will be obvious based on the blood tests and brain scans.

7. Side Effects

By using available technology to analyze brain functioning and blood samples, we may even be able to determine the exact causes of certain side effects. Currently we know that the pharmacological treatment causes side effects as a result of interactions with the central nervous system. It isn’t known exactly what leads a person to gain weight, experience sexual dysfunction, or become sleepy while on their medication.

If we used available technology, we would be able to come up with some specific reasons as to how certain people are reacting to the chemical administered. For example, if someone is given an antidepressant, and their baseline metabolism becomes significantly slower, there is a good chance that the person is going to gain weight – regardless of what they eat or how much they exercise. It would be helpful to note various interactions and lack of interactions based on individuals.

Furthermore, we could study various genetic factors that may contribute to how a person responds to a certain medication. Some people may carry a specific gene that makes them more prone to gaining weight while taking an SSRI, while others may carry a specific gene that makes them immune to influence from an SSRI on their weight. Doctors would be better equipped to inform their patients if they are more or less susceptible to side effects based on their specific physiological footprint.

8. Track Individual Variables

It is very important to establish individual factors that may be contributing to a particular mental illness.  In many cases, pharmaceutical treatments should only be considered long after a person has ruled out any lifestyle factors that may be contributing to depression.  For example, a person who doesn’t exercise, eats a lot of sugary foods, is stressed out from work, and gets barely any sleep may be able to fix their condition simply by making changes to address these contributing factors.

Most psychiatrists assume that you have already ruled out potential contributing factors on your own prior to pursuing pharmaceutical treatment for your mental illness.  The problem with this assumption is that it’s usually not true.  In fact, it is likely that a majority of people who pursue psychiatric treatment would rather take a pill than actually make (potentially difficult) lifestyle changes to improve their situation.

  • Ancestry: It is important to understand your ancestors because they may provide insight as to how you could treat your condition. Since everyone has different genetic roots, certain treatments that were effective for your blood relatives may also be helpful for you.  Since we do not yet have individual genomes cracked to know what genes are causing a person’s condition, learning about your ancestors and evolution may be helpful in coming up with treatments.
  • Behavior: Could the behavior that you’re engaging in be contributing to your mental illness? Many people do not realize that certain behaviors may be intertwined with their condition.  Making a conscious effort to correct various behaviors can be helpful in the treatment of a condition.
  • Cognition: Some people may think unrealistically as a result of their illness. The cognitive aspect of certain conditions like depression is often best targeted in cognitive-behavioral therapy (CBT).  This attempts to help a person think rationally about their condition as well as how to cope with it.
  • Dietary intake: This would involve tracking what a person is eating over time. The amount of food, quality of food, and specific foods a person eats can have an influence on how the brain and body function.  A person should be required to maintain a food log or journal that tracks what foods they eat, their caloric intake, etc.  A person may come to find that they are sensitive to certain foods and that elimination of specific foods may improve their condition.
  • Environment: What type of environment does the person live in? Do they live in a busy city, the suburbs, or are they from the country? Could a recent change in environment have contributed to a person developing a certain illness or condition?  Is the person safe in their current environment and/or are there any health risks?  These are all important questions to ask.
  • Exercise: It should be noted the type of exercise a person engages in, the duration, as well as the frequency (how many times a week). By tracking these factors, adjustments may be necessary to help optimize a person’s functioning.  For example, someone may be doing too much cardio and it could be contributing to poor focus.  Another person may not be getting enough cardio, yet another person may find that yoga or strength training elicits the greatest benefit for their mental health.
  • Genetics: In time, scientists will be able to identify certain genes that contribute to specific mental illnesses. They’ve already made a huge discovery identifying that schizophrenia is actually 8 diseases in one based on gene expression.
  • Heart-Rate Variability: There is some evidence suggesting that heart-rate variability may influence development of stress-based disorders like anxiety. In certain people with poor heart-rate variability, using a biofeedback type training to improve at this may be of significant benefit for their mental health.
  • Height: Even a characteristic like height may be collected strictly for data collection purposes. Is the person short, average height, or tall?
  • Income: It may be helpful to know how much a person is earning. There is some evidence to suggest that mental health may improve as a result of increased earnings.
  • Occupation: What does the person do for work? Are they satisfied with their job, occupational surroundings, and social interactions at work? If a person is extremely unhappy with this aspect of their life, perhaps a career change would improve their mental health and change their physiology.
  • Purpose: Does the person feel like they have a purpose? Many people with mental illness feel as if their life is devoid of meaning.  Helping a person find or establish some sort of meaning or identity may be beneficial for their mental health.
  • Relationships: How does the person perceive their relationships? Are their familial relations healthy, alright, or toxic?  How about their romantic relationships?  Are they healthy, average, or toxic?  If relationships of any kind are “toxic” the person may feel significantly better by exiting the relationship.
  • Sleep: It would likely be beneficial to know how many hours (on average) a person sleeps per night, as well as the quality of sleep that they’re getting. Then a person could specifically increase or decrease the amount of sleep they get as experimentation to determine how their mood is affected.
  • Socialization: How frequently does the person socialize? Someone who isolates themselves from society may experience significant depression, anxiety, etc. as a result of the social isolation.  On the other hand, someone who excessively socializes may be stressing themselves out as a result of too many commitments.  Finding an optimal balance for the individual may improve treatment outcomes.
  • Spirituality: Does the person have a spiritual connection? Could their lack of spirituality be contributing to their current depression or existential crisis?  While not everyone needs to be spiritual in order to thrive and achieve optimal mental health, many humans do.  It may be beneficial for some people to improve in this particular aspect of their life.
  • Stress: Another aspect that should be evaluated is external stress. In other words, what are the things in your life that are causing you to feel stressed.  If there are a significant number of stressors in your life, reducing that number may improve your condition and alter your physiology.
  • Weight: For tracking purposes, a person should be required to identify whether they are obese, overweight, average weight, or underweight. We may find that those of certain weight are more likely to be depressed.  Depending on the person, helping a person reach a healthier weight may improve their psychological health.

Above is a list of factors that should be considered both for research purposes as well as to identify potential factors that may be contributing to a person’s illness.  Certainly the argument could be made that a person became depressed and then… their sleep suffered, diet suffered, they lost their job, etc.  However, it is always important to keep in mind that poor self-care and sheer laziness may have also lead a person to fit the criteria for a certain diagnosis.

Perhaps the above list is actually too thorough, but then again maybe for some it isn’t thorough enough.  If a person who was previously sedentary and ate a bad diet changed their activity levels as well as the food they consumed, noticeable changes may occur in both their blood samples as well as on brain scans.  If psychiatrists wanted to be extremely thorough, they could track these factors alone, in combinations, or in addition to administration of medication.

Psychiatry needs targeted, individualized treatments

A major aspect of psychiatry that needs to be improved is that of coming up with targeted treatments and/or realizing if certain medications may be doing more harm to some people than good. Most psychiatrists currently follow standard protocol that involves listening to the symptoms that a person is complaining about, and prescribing a medication based on the symptoms that the person describes. While self-reporting should never be discarded, more information is necessary before determining a treatment strategy.

  • Targeted treatments: There is an overwhelming need for more targeted treatments. However, targeted treatments cannot be developed until researchers know the specifics. They could learn more specifics by using brain scans and thorough blood testing.  The targeting from a psychiatric standpoint would be to tailor the treatments to fit the observed pathology.
  • Individualized treatments: Diagnoses of various conditions are extremely general and we cannot assume that one person with “major depression” has the exact same physiology as another. There may be differing genetic activation in one person compared to the other. This may lead one person to experience low levels of serotonin, while the other may have low dopamine.  It would be necessary to customize treatments based on individual factors such as medication sensitivity, lifestyle, as well as genetic expression.

The current treatment strategy is extremely untargeted and isn’t usually based on the individual. Sure it is based on self-reports and a psychiatrist may attempt to use various antidepressant augmentation strategies if a person has a comorbid condition. Although this may actually work, for most people it is a shot in the dark. It is also important for psychiatrists to acknowledge that some people may not benefit (or actually feel worse) from available pharmaceutical treatments.

Improving psychiatric care is a costly pursuit, but necessary

Unfortunately, psychiatry is already extremely expensive. You have to pay a significant chunk of change just to get an appointment. Then you have to pay for the medications that you’re prescribed, even if they don’t work. Additionally, many individuals with mental illness barely have enough money scraped together to get any psychiatric treatment.

The problem with brain scans and blood tests is that it would mean significantly more costs on behalf of the patient. While the extra information would certainly be beneficial, most patients nor psychiatrists are concerned with going the extra mile and really understanding what’s going on with a person. Instead, they are concerned with using treatments that worked for a “majority” of people in clinical studies.

Sure the treatments that worked for a majority may end up being a great fit for certain patients, for others they will likely fail miserably. Had a psychiatrist known what was going on with a person (e.g. hypothyroidism or abnormal brain activity), they may administer or recommend a different treatment. As technology continues to improve and the costs of using old technology drop, we should see an improvement in the thoroughness of psychiatric care.

Whether psychiatrists actually decide to use all of the technology available to them for optimal care is a personal decision. If a select few psychiatrists start using thorough testing to really understand what is occurring with a person’s physiology, they should see an increase in business because their treatments will be a better fit for their patients. With all of the technology currently available, we can only hope that the field of psychiatry evolves by incorporating it into the practice.

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