To determine a patient’s mental health, clinicians have a conversation with their patient, asking them about their life, sleeping and eating habits, how they are feeling, and how medicines impact their moods. But these conversations may be manipulated by the patient on purpose if they wish to conceal their actual feelings, or the conversation may not give the complete picture if the patient is having a particularly bad (or good) day.
What if your doctor could measure a patient’s mental health in an objective way, without depending on what the patient says or doesn’t say? Efforts at UT Southwestern are hoping that artificial intelligence and biology-based testing can lead to an objective measurement of mental health and corresponding treatment.
Measuring Mental Health
Dr. Madhukar Trivedi, professor of psychiatry, chief of the division of mood disorders, and director of the Center for Depression Research and Clinical Care at UT Southwestern Medical Center wants mental health to be treated like other diseases and is leading the local effort. “We have got to develop objective tests that can help us diagnose people before they have the illness so that we can identify risks,” he says. “Then we match people to the right treatment.”
The COVID-19 pandemic has exacerbated the mental health crisis plaguing the country and is closely connected to everything from homelessness to opioid abuse. The social restrictions and mortality of the pandemic have increased mental health problems worldwide, and symptoms of anxiety and depressive disorder increased during 2020 relative to prior years. A Journal of the American Medical Association study found that depression was three times more prevalent during the pandemic than before, with lower-income individuals at greater risk.
The increased prevalence of depression mental illness means medicine needs a more scientific and biology-based way to measure and diagnose mental health. Physicians don’t diagnose patients with pneumonia purely based on fever because the fever can go up and down. Depression can be the same. A day or a few hours of positive interactions can make someone feel better, but that doesn’t change the chemical imbalance in a patient’s brain.
Trivedi says that within a matter of years, there will most likely be brain and blood tests that can identify mental illness early, allowing physicians to diagnose the problem and recommend treatment. The brain works like a circuit, and once scientists can map and understand how a fully functioning course works, they can see where problems exist and work to fix broken connections.”You might not remember that it’s been terrible two days or two weeks back,” Trivedi says. “If we have an objective test, then it becomes much clearer. While today you may be feeling okay, your blood tests or your brain tests are showing that these circuits are still not functioning adequately.”
Right now, treating mental health is more subjective than that, with clinicians trying different treatments or medicines and finding the right balance. But for those who suffer from depression, one of their significant hurdles is doubt about their ability to get better. “The doctor says, ‘Let’s try this; it may or may not work.’ That’s a very depressing thing for the patient,” Trivedi says. “If we have these tests, then that helps them feel more confident that this is worth trying.”
Creating objective tests can also help address the stigma surrounding mental health, as so much is perpetuated by lack of understanding and a feeling that those who suffer are faking it or keeping themselves sick. If someone is diagnosed with breast cancer, there is no shame associated with that diagnosis, in part because there are objective scans, biopsies, and imaging to prove that there is, in fact, disease. Trivedi hopes his research can create similar feelings about mental health. “I think that will go a long way in all this conversation about stigma and mental health. The stigma comes from lack of knowledge and lack of an objective test, and if we can do this, then we can change the conversation,” he says.
For years, Trivedi has worked on studies to develop these tests. In work published in Nature Biotechnology, he led a study that analyzed 300 patients with depression and used an EEG to measure electrical activity in the patients’ cortex before receiving treatment. Next, researchers used machine learning to predict which patients would benefit from the medication within two months accurately. Looking ahead, they will look for FDA approval for the artificial intelligence that can help measure brain activity as it connects to mental illness.
Trivedi is partnering with clinics around the state and being propelled by funding from the state and the National Institutes of Health to expand these developments and change the way mental health is treated. It is not a glamorous or well-paying endeavor, but Trivedi is focused on impact, not accolades. “If I were doing the work I was doing in cancer or if I was doing this in a metabolic syndrome or diabetes, then the world would pay big bucks to help us do it,” he says. “This takes more effort, but that’s the excitement, right? I’m trying to change something transformational. We are at the forefront. Nobody else is doing this in the country.”