When people think of patients being treated for depression, usually what comes to mind is someone sitting in weekly therapy sessions, and perhaps being prescribed a medication. But some clinicians and technologists see other ways to help patients manage depression.

One alternative approach to treating depression is called precision psychiatry. It uses clinically reliable indicators of brain function to develop objective, brain-based patient categories – known as neurotypes – to target therapy. 

By identifying a patient's subtypes of depression via EEG wearables paired with a digital interface, interpretable data can be surfaced about the patient's cognitive and emotional abilities, aiding with diagnosis and treatment decisions.

This approach can aid clinicians in diagnosis and treatment decision making in patients with depression, said Dr. Kazu Okuda, founder and CEO of Universal Brain, a Los Altos, California-based technology start-up.

Universal Brain has developed a gamified neurofeedback treatment system that modulates the brain activity associated with symptoms of depression – a form of precision psychiatry.

We interviewed Okuda, a psychiatrist, to talk about how home-based, technology-facilitated care can help in the treatment of depression. 

We spoke about shortcomings to treating depression in traditional ways; precision psychiatry and advances in neuroscience, genetics and technology; neurotyping depression based on specific patterns of brain function; and the home-based wearable health technology his company created and how it can help treat depression.

Q. How can home-based care help in the treatment of depression (especially given the current national shortage of specialists such as psychiatrists), and what role does technology play?

A. The diagnosis and treatment of depression has never been based on objective measures, and the resulting trial-and-error approach has proven costly and produced mixed results in terms of effectiveness. Meanwhile, access to care continues to be an issue and is exacerbated by the worsening shortage of mental health specialists.

Research shows 20% of American adults will face a severe form of depression at some point in their lives, while some estimates indicate 8% of the workforce has a diagnosis of major depressive disorder. The financial burden of depression on U.S. employers is staggering, amounting to an annual cost of roughly $187.8 billion – including $134 billion in physical and mental health treatment.

Meanwhile, nearly 74% of Americans seeking help turn to their primary care physician rather than a mental health professional. But in the primary care setting, depression is often overlooked, with misdiagnosis occurring in approximately 50% of cases.

Now, with advanced technology that brings precision medicine to psychiatry, we can enable care in any setting – including the home – and provide crucial objective measures to advance diagnosis and treatment.

In addition to improved access to care, one of the key advantages of home-based care for depression is the ability to provide patients with a more comfortable and familiar environment compared with traditional clinical settings.

With the advent of portable and affordable electroencephalography (EEG) technology, patients will be able to undergo diagnostic assessments and monitor their treatment progress from the comfort of their own homes. This not only makes the process more convenient and accessible but also allows for more frequent and consistent monitoring, enabling healthcare providers to make timely adjustments to treatment plans as needed.

Already, technology plays a vital role in enhancing the delivery of home-based care for depression. Telemedicine platforms, for example, can facilitate remote consultations, even in areas with limited access to specialists.

Digital tools such as smartphone apps and online self-help programs also can provide patients with valuable resources. The next critical step is incorporating objective measures into remote diagnosis and treatment.

Q. You say there are shortcomings to treating depression in traditional ways. What are they?

A. Traditional depression treatment too often falls short due to its homogenous nature, which fails to account for the heterogeneity of the disorder. There are many subtypes of depression, and not one single "depression." Consider the traditional trial-and-error approach to medication management.

Antidepressants, while effective for many patients, do not work for everyone, and finding the right medication and dosage can be a lengthy, frustrating and costly process. This is largely because current diagnostic methods are widely based on subjective measures and do not consider specific neural biomarkers that contribute to an individual's depression, making it difficult to predict which treatments will be most effective for a given patient.

Traditional approaches often fail to address the full spectrum of symptoms and challenges associated with the many different subtypes of depression. By not tailoring treatment plans to the specific needs and characteristics of each patient, traditional approaches may leave many individuals with residual symptoms and a reduced quality of life.

And healthcare providers may overlook the unique characteristics and underlying neurobiological mechanisms that distinguish different subtypes of depression, leading to suboptimal treatment outcomes and prolonged patient suffering.

Today, there is a growing recognition of the need for a more personalized and data-driven approach to depression diagnosis and treatment. By leveraging advanced neurobiological diagnostic tools, healthcare providers can gain a more comprehensive understanding of the underlying factors that contribute to an individual's depression.

This knowledge then can be used to develop targeted treatment plans that address the specific needs and challenges of each patient, ultimately leading to better outcomes and a more efficient use of healthcare resources. 

As the field of precision psychiatry continues to evolve, it holds great promise for reforming the way we diagnose and treat depression, offering new hope for the millions of individuals who struggle with this complex and debilitating disorder.

Home-based approaches to diagnostics and treatment can employ innovative approaches like neurotyping, which uses event-related potentials to gain a more comprehensive understanding of an individual's unique depression profile.

By identifying specific patterns of brain activity associated with different subtypes of depression, neurotyping enables healthcare providers to develop personalized treatment plans that target the underlying neurobiological mechanisms of a patient's condition. This precision psychiatry approach has the potential to significantly improve treatment outcomes and reduce the time and resources spent on ineffective therapies.

Q. What is precision psychiatry, and how can it level up treatment based on advances in neuroscience, genetics and technology?

A. Precision psychiatry offers a novel approach to matching patients with the most appropriate and effective treatments in a more timely manner by leveraging progress in science and technology. This burgeoning discipline aims to create personalized treatment strategies that are customized to everyone's unique combination of health concerns, traits, strengths and symptoms.

Central to the concept of precision psychiatry is the use of neurotyping.

This personalized approach recognizes that conditions such as depression are not singular, but rather heterogeneous with varying symptoms, underlying causes and optimal treatment strategies. By moving away from a one-size-fits-all approach and toward a more individualized model of care, precision psychiatry aims to improve treatment outcomes, reduce the burden of patients with mental health problems, and enhance the overall quality of life for patients.

Neurotyping involves classifying patients based on their specific patterns of brain function. By using advanced diagnostic tools, such as neuroimaging and portable EEG technology, healthcare providers, researchers and drug developers can gain a more comprehensive understanding of the underlying neurobiological factors contributing to an individual's depression by focusing on distinct measurements or biomarkers.

This information then can be used to develop targeted treatment plans that address the specific needs and challenges of each patient, potentially leading to more effective interventions and faster symptom relief.

As precision psychiatry evolves, it's essential to recognize the importance of a comprehensive and data-driven approach to mental healthcare. By embracing the concept of multiple "depressions" and acknowledging the unique nature of each individual's experience, healthcare providers can foster a more compassionate and destigmatizing environment for patients seeking treatment.

Neurotyping also has the potential to transform psychiatric clinical drug trials by recognizing subsets of patients with unique neural signatures who are more likely to respond favorably to certain treatments. This approach may increase the chances of identifying therapeutic benefits and expedite the development of new medications.

Moreover, by investing in the development of innovative diagnostic tools, personalized treatment options and accessible care models, the healthcare community can work toward transforming the lives of the millions of individuals affected by depression and paving the way for a brighter, more hopeful future in mental healthcare.

Q. What is neurotyping depression based on specific patterns of brain function, and why do you consider it important for effective treatment?

A. Neurotyping is a promising approach within precision psychiatry that aims to classify patients based on their specific patterns of brain function, enabling clinicians to develop more effective and personalized treatment plans for depression.

By using functional brain biomarkers, such as those obtained through EEG, neurotyping seeks to identify distinct neural signatures associated with different subtypes of depression. This approach recognizes that depression is not a homogeneous disorder but rather conditions with varying underlying neurobiological mechanisms.

The importance of neurotyping for effective depression treatment lies in its ability to provide a more nuanced understanding of each patient's individual profile. By analyzing functional brain biomarkers, clinicians can gain insights into the specific neural systems involved in a patient's particular subtype of depression.

This information is crucial for developing personalized treatment plans that target the root causes of an individual's symptoms, rather than relying on a one-size-fits-all approach. By tailoring interventions to the specific neurobiological factors contributing to a patient's depression, neurotyping has the potential to improve treatment outcomes, reduce the risk of side effects and accelerate symptom relief.

The advent of portable and affordable EEG technology has made neurotyping an increasingly accessible and practical tool for depression diagnosis and treatment monitoring. Wireless EEG headsets, for example, offer a patient-friendly and convenient means of obtaining functional brain biomarkers in various settings – from clinics to patients' homes.

This not only simplifies the diagnostic process but also allows for more frequent and consistent monitoring of treatment progress, enabling clinicians to make timely adjustments to treatment plans as needed. The use of event-related potentials in neurotyping provides an even more granular understanding of individual patient profiles, facilitating the development of highly targeted and personalized interventions that address the specific aspects of a patient's depression.

As the field of precision psychiatry continues to evolve, neurotyping is poised to play an increasingly key role in transforming the landscape of depression treatment, offering hope for more effective, efficient and patient-centered care.

Q. What is the home-based wearable health technology your company created and how can it help treat depression?

A. Our solution addresses the significant challenges faced in treating mental health conditions. By providing accessible, effective and personalized care, we aim to transform the lives of those struggling with depression and other conditions.

Central to our approach is the Universal Brain platform, which consists of a next-generation, wireless EEG wearable, our Neurotique System that delivers a task-based ERP measurement system, and advanced algorithms that enable precision treatment for patients and clinicians.

This platform offers objective measures to understand, diagnose and treat brain disorders – specifically, depression. By leveraging next-generation digital endpoints and digital biomarkers, Neurotique enables precision psychiatry, tailoring treatment plans to the unique neurobiological profiles of individual patients.

The impact of our technology is expected to be far-reaching, initially transforming drug development by providing more accurate and targeted methods for assessing the efficacy of novel therapeutics. As the platform evolves, it will become a diagnostic tool for healthcare providers, empowering them to make more informed decisions about patient care and treatment selection.

Ultimately, the plan is for the Neurotique System to serve as a comprehensive option for patients, offering personalized neurofeedback training and other targeted interventions that address the specific neurobiological factors contributing to their condition.

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