A blood test using RNA markers offers new hope for people with mood disorders such as depression in what could be an important advance in diagnosing mental health conditions.
A team from the Indiana University School of Medicine launched the blood test in April, claiming it is psychiatry’s first biological answer to a mood disorder diagnosis.
said psychiatrist and geneticist Dr. Alexander Nikulscu, who led the research team.
This avoids years of trial and error, hospitalization, and side effects. Because these are very common disorders, we believe we can do a lot of good with this test and other tests and applications we have developed.”
The study investigated the biological basis of mood disorders, and developed a tool to characterize the type of mood disorder a person had — depression or bipolar disorder.
To develop the test, Dr. Niculescu’s team drew on 15 years of previous research into how psychiatry relates to biomarkers of gene expression in the blood – measurable indicators of biological status in the form of RNA, DNA, proteins or other molecules.
Every system in the body — the brain, nervous system, and immune system — has a common developmental pathway, says Dr. Niculescu.
“For example, when you’re stressed or depressed, there are psychological and nervous mechanisms, hormones and other things that are secreted and affect your blood and your immune system,” he told Al Jazeera.
Conversely, immune activation or inflammation may affect the brain.
In the first phase of the study, the team identified a list of RNA biomarkers that can track states of moods over a period of time. After being validated in an independent group of people with clinically severe depression and clinically severe mania, they finalized 26 biomarkers, which were scaled back to 12 by further testing.
With these results, doctors will be able to send patients to a lab for blood testing to determine the causes of their symptoms, just as they would with physical illness, says Dr. Niculescu.
Biomarkers can also help with treatment because some have been found to be affected by selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants. Three others were identified in previous work as being affected by lithium carbonate – a mood stabilizer used in bipolar therapy.
“Depending on which of those biomarkers are changed [a patient], we have a list of medicines … arranged by their compatibility [the patient’s] Dr. Niculescu said.
The blood tests developed by Dr. Niculescu and his team are now available as CLIA tests for physicians to order, via a company set up by Niculescu and other experts in the field. CLIA is a set of US government standards for laboratories that test human samples for health assessment or for the diagnosis, prevention, or treatment of disease.
But according to Alexander Talkowski, a program officer in the Translational Research Division at the National Institute of Mental Health (NIMH) in the US, there is still research to be done. The main issue, he adds, is whether the findings are replicated by independent researchers.
To some extent, this process took place within the study itself, says Dr. Niculescu, with several steps of testing and validation in independent cohorts. According to the study, promising results were also generated by independent, large-scale genetic studies released after the study was completed.
But what if the hypothesis of the study is incorrect in itself?
Professor Ian Hickey, Associate Director of Health and Policy at the University of Sydney’s Brain and Mind Center and former National Commissioner for Mental Health in Australia, argues that finding a single algorithm that applies to all mood disorder patients is unlikely because disorders are also individual and based on clinical presentation at different stages of life. .
Instead, his team links physiology and biology to individuals’ symptoms, not their disease category.
“What are really disordered systems? How are they represented? What signs can you detect?” he said. “And [then] What is the combination of biological, behavioral and other therapies that correct the situation … and then keep you healthy? “
Essentially, all of these findings can be used in conjunction with a clinical evaluation for a more accurate and conclusive diagnosis and treatment, he says.
Objective tests can change early diagnosis
Objective testing can be of great interest to patients who are currently going through a very slow diagnostic process.
For bipolar disorder in particular, it can take years for the full range of symptoms to appear.
Oftentimes bipolar disorder will present itself first as depression, with manic symptoms appearing later, says Sydney psychiatrist Dr Sonia Kumar.
Other times, symptoms may be present but are so low in the spectrum that the diagnosis is unclear until you have developed.
If there is a biological test that can clarify these variables along with a clinical evaluation, doctors can start accurate treatment early, which could ease much of the suffering before it even occurs, Kumar says.
Catherine Insey, a research assistant, believes that an early diagnosis of her bipolar disorder can not only save years of unresolved suffering, but also save her from the severity of her post-diagnosis episodes.
She was diagnosed with depression at age 13 and prescribed Zoloft, a type of antidepressant well known to induce mania in patients with bipolar disorder.
“[It] It drove me into a frenzy that lasted until I was 19, when I was first hospitalized.”
After her hospitalization, when Ency finally received the correct diagnosis, she began what would be 10 years of trying new drugs, navigating bipolar episodes and searching for wellness.
She believes that had she been properly diagnosed at age 13, her illness would not have become so severe.
Research shows that both bipolar depression and unipolar depression are degenerative diseases.
“If I had received treatment earlier… I would have had fewer episodes,” Ensi told Al Jazeera. “I see it as [fewer] Being hospitalized, which would have saved me tons of money and tons of time, and tons of anguish.”
Dr. Niculescu says that objective testing for mood disorders like this blood test could also be key to reducing the stigma associated with mental health conditions.
“People will realize it’s just a biological disorder…it’s not a moral weakness, you’re not lazy etc,” he says.
Violet, the Russian model who prefers to share only her first name, has been living and working through depression for years.
She says she has internalized the stigma and often feels like a “liar”.
“Sometimes I feel … seeking attention or something,” she said. “These are things that you get accused of a lot, even by people close to you… and then you start to wonder if you’re actually just a selfish person who wants a lot of attention?”
The data goes a long way to dispel this suspicion, explains Kasia, an NGO worker in Sydney who asked that only her first name be used.
She compares her diagnosis of depression as an adult to when she was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) as a child.
Because tests were created to diagnose ADHD, I was able to see objective results for her psychological evaluation.
“They actually showed me all my brain scans and showed me how different my mind was. It was such a big day for me, it changed everything,”
Kathmandu psychiatrist Dr. Pawan Sharma says such a test could further break down barriers to providing care among his patients, particularly those from isolated rural communities where there is low cultural awareness of mental illness.
Many of these patients don’t initially realize that grief can be an illness, says assistant professor in the department of psychiatry at the Bataan Academy of Health Sciences.
“They come [to physicians] With physical symptoms – with headaches, insomnia, loss of energy, heart palpitations – an illusion [are then referred] to psychiatrists,” noting that objective testing would give patients something tangible to help explain what they are feeling.
As it stands now, says NIMH’s Talkovsky, Dr. Niculescu’s study goes a long way to making this happen and pushing psychological research forward.
“What they’re doing is a very important step in our ability to generate objective tags [for] “Mental illness,” he said.
While it is still early days, with more research, the study’s blood test may become an important part of the psychiatric toolkit, bringing clarity to diagnosis and potentially changing the lives of millions of people for the better.