The test will survive the ‘years of trial and error’ that currently characterize the diagnosis and treatment of mental health conditions.
A blood test using RNA markers is offering new hope for people with mood disorders such as depression that could be a significant breakthrough in the diagnosis of mental health conditions.
A team from the Indiana University School of Medicine launched the blood test in April, claiming it was the first biological answer to psychotherapy for diagnosing a mood disorder.
“Our study shows that it is possible to perform blood tests for depression and bipolar disorder, which have clinical utility, can differentiate between the two, and match people to the right medications,” said psychiatrist and geneticist Dr. Said by Alexander Niculescu, who took the lead. Research.
“It avoids years of trial and error, hospitalization and side effects. Since these are very common disorders, we think we can do a lot better with this and the other tests and apps that we have developed.
The study looked at the biological basis of mood disorders, developing a tool to distinguish which type of mood disorder a person has – depression or bipolar disorder.
To develop the test, Dr. Niculescu’s team drew on their past 15 years of research into how psychopathology relates to blood gene expression biomarkers – measurable indicators of biological state in the form of RNA, DNA, proteins or other molecules.
Every system in the body—the brain, the nervous system, the immune system—has a normal developmental pathway, says Dr. Niculescu.
“For example, when you’re stressed or depressed, psycho-neurological mechanisms, hormones and other things are released that affect your blood and your immune system,” he told Al Jazeera.
Conversely, an immune activation or inflammation would affect the brain.
In the first phase of the study, the team identified a list of RNA biomarkers that can track mood state over time. After validating them in an independent cohort of subjects with clinically severe depression and clinically severe mania, they finalized 26 biomarkers, which they reduced through further testing to 12. done.
With these findings, doctors will be able to send patients to a lab for bloodwork to pinpoint the cause of their symptoms, just as they would for a physical illness, Dr. Niculescu says.
Biomarkers may also help with treatment because some of them were found to be affected by selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants. In previous work three others were identified to be affected by lithium carbonate – a mood stabilizer used in bipolar treatment.
“Based on which of these biomarkers are changed” [a patient], we have a list of drugs … sorted by how strongly they match [the patient’s] biological profile,” said Dr Niculescu.
The blood tests developed by Niculescu and his team are now available for physicians to order as CLIA tests through a company founded by Niculescu and other experts in the field. The CLIA is a set of US government standards for laboratories that test human samples for health evaluation or for the diagnosis, prevention, or treatment of disease.
But according to Alexander Talkovsky, a program officer in the Division of Translational Research at the National Institute of Mental Health (NIMH) in the United States, there is still research to be done. The main issue is whether the findings have been replicated by independent researchers, he adds.
This process has been carried out to some extent within the study itself, Dr. Niculescu says, through several stages of testing and validation in independent groups. According to the study, the independent large-scale genetic studies that were released after the study was completed also produced promising findings.
But what if the premise of the study itself is wrong?
Professor Ian Hickey, co-director of health and policy at the University of Sydney’s Brain and Mind Centre, and a former National Mental Health Commissioner in Australia, argues that it is unlikely to find an algorithm that is applicable to all mood disorder patients because the disorder is so These are individual and based on the clinical presentation at different stages of life.
His team is instead linking physiology and biology to individual people’s symptoms, not the category of their disease.
“Which systems are really troubled? How are they represented? What are the markers that you can detect?” she said.” [then] What is the combination of biological, behavioral and other treatments that cures the condition…and then keeps you healthy?”
Essentially, all of these findings can be used in conjunction with clinical evaluation for more accurate and conclusive diagnosis and treatment, he says.
Objective tests may replace early diagnosis
Objective testing can be very important for patients who are currently going through an extremely slow process of diagnosis.
For bipolar in particular, it can take years for the full range of symptoms to develop.
Sydney-based psychiatrist, Dr Sonia Kumar, says that often bipolar disorder will first manifest itself as depression, with manic symptoms emerging later.
Other times, symptoms may be present but so few on the spectrum that the diagnosis is not clear until they develop.
If there was a biological test that could clarify these variables along with a clinical evaluation, Kumar says, doctors could begin accurate treatment earlier, which could reduce a lot of suffering before it even occurs. .
Research associate Katrin Inci believes that early diagnosis of her bipolar disorder could not only have saved her years of unresolved suffering, but also increased the severity of her episodes after diagnosis.
She was diagnosed with depression at age 13 and was prescribed Zoloft, a type of antidepressant known to induce mania in bipolar patients.
,[It] put me into a manic episode that lasted until I was 19, when I was first admitted to the hospital,” she said.
After her hospitalization, when Inci finally got a correct diagnosis, she began what would be 10 years of trying new drugs, navigating bipolar episodes, and searching for wellness.
He believes that if he had been diagnosed correctly at the age of 13, his illness would not have been so severe.
Research shows that both bipolar and unipolar depression are degenerative diseases.
“If I had been treated earlier… I would have had fewer episodes,” Inci told Al Jazeera. “I see it as [fewer] Hospitalization, which would have saved me a lot of money and a lot of time, and a lot of pain. ,
An objective test for mood disorders such as this blood test may also be important for reducing the stigma associated with mental health conditions, says Niculescu.
“People will realize it’s just a biological disorder… it’s not a moral weakness, you’re not lazy and so on,” he says.
Violet, a Russian model who prefers to share only her first name, has been living and working in depression for years.
She says she has internalized the stigma and often feels herself a “liar.”
“Sometimes I feel like… I’m asking for attention or something,” she said. “These are things that you get accused of a lot, even from people close to you… and then you start thinking what if I’m really just a selfish person who’s too much Wants attention?”
The data goes a long way to dispel the doubts, says Sydney NGO activist Kasia, who asked that only her first name be used.
She likens her diagnosis to depression as an adult to when she was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) as a child.
Because the tests are designed to diagnose ADHD, she was able to see objective results for her psychiatric evaluation.
“He actually showed me all my brain scans and showed me how my brain was different. That was a huge day for me, it changed everything,” she said.
Dr Pawan Sharma, a Kathmandu-based psychiatrist, says such testing could lead to even greater barriers to care among his patients, especially in more rural, isolated communities, where there is less cultural awareness of mental illness. can break.
Many of these patients are not initially aware that sadness can be a disease, says an assistant professor in the department of psychiatry at the Patan Academy of Health Sciences.
“They come [to physicians] accompanied by physical symptoms – headache, insomnia, lack of energy, heart palpitations – and they [are then referred] for psychiatrists,” Dr Sharma said, noting that an objective test would give patients something concrete to help explain how they are feeling.
As it stands now, Dr. Niculescu’s study goes a long way toward achieving this and advancing psychological research, says NIMH’s Toclowski.
“What they’re doing represents a very important step forward in our ability to make objective markers [for] Mental illness,” he said.
While it’s still early days, with further research, the study’s blood test could still become an important part of the psychiatric diagnostic toolkit, bringing clarity to diagnosis and potentially changing millions of lives for the better. .