02 Jan Science in Mental Health Care: The Importance of Blood Tests in Effective Treatment
Historically, diagnosing mental illness is not like diagnosing other chronic diseases. MRIs, X-rays, nor EKGs can detect the presence of a psychiatric illness. As recent as 2012, psychiatric professionals have claimed that identifying a mental illness is more “subjective.” The American Psychological Association reported in 2012 that “no blood test exists for depression…At least, not yet.” Over the years, there has been much debate that psychiatry is a “pseudo-science,” but emerging science in the form of blood tests may be about to change all of this.
The diagnosis of a psychiatric illness has historically been accomplished through the review of subjective complaints and the duration and severity of these symptoms. A person complaining of low mood, a loss of interest in activities they previously enjoyed, increased sleep, weight gain, and changes to their connectedness in interpersonal relationships over the past six months would likely garner a diagnosis of a mood or depressive disorder. Medicine has looked down on psychiatric practitioners, sometimes to the extent that they do not recognize them as medical doctors. There are often misconceptions about mental health diagnosis and care, that there is no biological or scientific basis for psychiatric illness. Additionally, that some erroneously believe that psychiatric medications do not make things better and are just pushed by pharmaceutical companies. The science behind detection of a psychiatric illness and mental health care through bloodwork, however, may be changing.
The use of blood tests in mental health care is not new. Frequently, practitioners would utilize blood tests to help rule out any medical cause for seeming mood disturbances. For example, individuals with significant depressive symptoms may be experiencing these as a symptom related to hypothyroidism. This is caused by an underactive thyroid, where the organ does not produce enough hormones to properly moderate the body’s metabolism and other essential functions. In this condition, the physical symptoms can mimic those of depression such as tiredness, slow thoughts, weight gain, and depressed mood. A practitioner will look to confirm that there is not an underlying medical cause for the changes in mood through bloodwork in the process of diagnosing a person with a mental illness. Other medical conditions that may present with symptoms of change in mood or cognitive functioning, causing an inaccurate psychiatric diagnosis, could include diabetes, chronic fatigue syndrome, or Alzheimer’s disease.
Over the past few years, another use for bloodwork in the diagnosis and treatment of psychiatric illness has been utilized. There has been a rise in the use of genetic testing through bloodwork to improve the efficacy of psychiatric medication usage. This is a relatively new practice in the past 10 years. Companies now offer to psychiatrists the ability to order blood tests to help them choose the best anti-depressant based on the person’s genetic make-up. These blood tests look for genetic markers that will predict how that patient will metabolize an anti-depressant medication. While this science appears promising in the pharmacological treatment of many medical concerns such as cancer treatment, there is limited empirical evidence at this point that these tests produce positive results in the selection of an effective antidepressant.
A study conducted in 2017 and published in the Ontario Health Technology Assessment Series found that there was minimal definitive data around the efficacy of antidepressants selected using genetic testing over those chosen based on practitioner expertise. Additional research reported in JAMA Psychiatry in 2018 found that other environmental factors more predictive in the metabolism of an anti-depressant such as age, gender, or diet than the genetic predisposition for drug metabolism. The study concluded that the use of bloodwork for genetic selection of medication in the treatment of mental illness will not contribute to outcomes. In fact, in 2018, the American Psychological Association convened a task force to identify the efficacy of the use of gene testing in psychotropic medication prescribing practices. The researchers in this effort identified that while there is a promising future for genetic blood testing in treatment for mental illness but recommended that “we don’t feel we are there yet.”
The next advancement in bloodwork in the treatment of mental health conditions may include the use of genetic biomarkers found in blood to predict if a person will or has developed a psychiatric illness. A recent study explored the correlation of blood biomarkers and mental health conditions, and while the results are not conclusive, there was suggestive evidence that mental illness can be predicted through biomarkers. The ability to identify depression or schizophrenia, or pre-disposition for such illnesses through examining blood biomarkers could revolutionize mental health care. While more research is necessary, these discoveries can help us to understand what causes mental illness.
Decades of treating mental health conditions has demonstrated the need for integrated approaches to caring for the whole person and we know that mental health and physical health are interdependent upon one another. The use of blood work in mental health care offers opportunities for early detection and better treatment for improved outcomes in care.