Blood Tests for Diagnosis of Schizophrenia and Depression?

By Arline Kaplan | August 10, 2011

Test benefits

Both Renshaw and Williams believe the test will have benefits for primary care and psychiatry. “The technology will become a standard of care in both primary care and in psychiatry,” Renshaw predicted.

“Too many people with depression are not diagnosed using standard clinical assessment measures,” he said. “Moreover, there is also a real possibility that the Ridge biological marker technology will be useful in optimizing treatment selection by assessing 4 different marker domains (neurotrophic, metabolic, immune, and endocrine).”

Williams added that in the company’s main market research, psychiatrists reported up to 30% of their depressed patients are difficult to manage, do not comply with their treatment plan, and have work and family issues.

“By having a biological indication of depression, patients and their families have an improved understanding of the condition as a medical one, which reduces the stigma associated with mental health disorders and leads to an improvement in treatment compliance. We have several case studies citing examples of the test results being used by psychiatrists to improve communications with their patients and ultimately improve outcomes,” she said.

A simple blood test can also greatly assist primary care physicians in distinguishing true depression from overlying symptoms, particularly in situations of chronic pain or where patients cannot “self-report.”

“Market research,” she added, “also suggests that up to 50% of MDD cases are missed at the primary care level, leading to delayed treatment and other unnecessary, costly diagnostic evaluations.”

Simplified blood test

At the Japanese Society of Biological Psychiatry Conference in Tokyo last May, researchers reported devising a test that measures the concentration of phosphoric acid in the blood as an indicator of major depression.

Noriyuki Kawamura, MD, PhD, of the Gaien Mental Clinic in Tokyo, and Yoshiaki Ohashi, PhD, board member and chief security officer at Human Metabolome Technologies, Inc (HMT), a spinoff biotechnology company from Keio University, led the research project. This particular project was conducted independently from Keio University.

HMT’s “patented metabolomics techniques using Capillary Electrophoresis-Mass Spectrometry (CE-MS) enabled simultaneous measurement of more than 500 metabolites in blood plasma,” said Ohashi, who is also leader of biological research at HMT and a part-time lecturer at Keio University.

The simultaneous and comprehensive measurement of metabolites in plasma from depressed subjects (n = 34, diagnosed at the National Center of Neurology and Psychiatry in Kodaira, Tokyo) and demographically matched nondepressed subjects (n = 38) resulted in the identification of the new depression biomarker, ethanolamine phosphate (EAP), according to Ohashi. The study showed that patients with depression had lower plasma concentrations of EAP.

The marker (EAP), Ohashi added, is sensitive enough and accurate enough to diagnose major depression (true positive rate, 82%; true negative rate, 95%).

“We are developing a reagent to gauge the level of EAP within minutes,” Ohashi said. “We expect to complete the development of reagent in a year and to seek health ministry approval after conducting clinical trials.”

To conduct clinical trials of the depression test, HMT is attempting to recruit more than 1000 participants from the Gaien Mental Clinic and another research clinic in Tsuruoka, Japan. A journal article on the biomarker research also is being submitted.

Speaking about benefits of the test, Ohashi told Psychiatric Times, “the guidelines for diagnosing depression include elements that are difficult to capture objectively; for example, ‘insomnia or hypersomnia nearly every day,’ ‘loss of energy,’ and so on. What should doctors do if patients falsely report their symptoms? On the other hand, some depressed patients might underplay their symptoms because of the stigma of disclosure and perhaps because of the fear of receiving antidepressants. We have identified a biomarker of major depression that correlates with diagnosis by an experienced psychiatrist. This is very good news for general practitioners to whom many depression patients go at the first visit.”

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by Carla Thomas | September 22, 2011 4:53 PM EDT

The use of blood tests to diagnosed neurological disorders (i.e., psychiatric disorders) is long overdue. I agree that such tests will reduce the negative stigma associated with neurological conditions & the perception that those suffering with such disorders can simply change their behavior or receive conditioning techniques to free themselves from the disorder. The change in perception from the mind model to the neurological condition model will increase one's willingness to use medications to improve neurologic function. Now, if we can eliminate the negative stigma associated with terms such as, psychotic & psychiatric, so many people suffering with neurological conditions will become more open to seeking medical support to treat their symptoms. In the end, psychiatric conditions are neurological disorders because they stem from anomalies in genes/cells that impact brain function.

by Daniel Carlat | August 15, 2011 3:30 PM EDT

The depression blood test marketed by Ridge Diagnostics is something of a boondoggle. The two question PHQ-2 test is highly sensitive and specific for depression, and does not cost $745! See my post on this "biomarker" at http://carlatpsychiatry.blogspot.com/2011/08/blood-test-for-depression-really.html.

by Stephen Durrenberger | August 15, 2011 11:16 AM EDT

This is certainly a significant breakthrough for psychiatry, however, we must be careful not to draw too sweeping a conclusion from such research. While the blood test for Schizophrenia has great potential in helping identify patients earlier, I am deeply concerned that developing a blood test for MDD will lead to further short-cutting in the evaluation of patients by psychiatrists. It is prudent to note that the blood test CONFIRMED diagnoses that had previously been determined, but DID NOT CHANGE with medication treatment. This could mean that the individuals were biologically predetermined to develop depression, or, more likely, could indicate that medication alone is not adequate treatment for depression. Recent literature reminds us that the doctor patient relationship is far more important that once believed, when measuring response to treatment. The doctor needs to connect with the patient, adequately evaluate the patient, and pay attention to the social factors that lead to and fuel ongoing depression. We have abdicated the treatment of our patient population to primary care practitioners, alternative practitioners, and non-MD therapists for so long, we are losing touch with the essential roots of our profession. Evaluating and treating patients with depression should involve a detailed interview by the psychiatrist, not a 15 minute once-over and a blood test. Based upon the cost of the test, it is clearly more cost-effective to do the former, rather than the latter, so let us hope that the psychiatric community does not further abdicate its position, now to laboratory scientists!

by Robert Sands | August 12, 2011 11:01 AM EDT

This mechanistically diverse basket of markers with relevant physiologic underpinnings is quite interesting, especially if it has "85% specificity and sensitivity". I have watched many markers come and go with varying degrees of value. I always come back to the clinical reality, which is the basis for judging the markers value in the end. Brain imaging "markers"(patters of blood flow or activity)have teaching value but are generally of little value in the individual case

The "marker" approach will have more use in genetic counseling and working with family members of mentally ill than with those individuals with established mental illness who could care less about their markers, since they already have the full expression clinically. If the markers (basket of markers) could predict penetrance of illness (which is quite variable) that would be a big deal. It would help define the Cannabis/pychosis risk group.
Robert E. Sands, MD

References

1. Holmes E, Tsang TM, Huang JT, et al. Metabolic profiling of CSF: evidence that early intervention may impact on disease progression and outcome in schizophrenia. PLoS Med. 2006;3:e327.
2. Schwarz E, Izmailov R, Spain M, et al. Validation of a blood-based laboratory test to aid in the confirmation of a diagnosis of schizophrenia. Biomark Insights. 2010;5:39-47.
3. Schwarz E, Guest PC, Rahmoune H, et al. Identification of a biological signature for schizophrenia in serum. Mol Psychiatry. 2011 Apr 12; [Epub ahead of print].
4. Ridge Diagnostics. Improving the Diagnosis of Major Depressive Disorder: a New Multi-Analyte Biomarker Panel and MDDScore. October 18, 2010.

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Blood Tests for Diagnosis of Schizophrenia and Depression?

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