Biomarkers for treatment?
“Biomarkers as diagnostic tools may take the humanity and subjective experience out of psychiatry. The diagnosis really has to stem from a person’s subjective difficulties, the complications that the disease cre-ates in the patient’s life, and what the doctor recognizes in them that makes them different from what we consider normal.” Balt said.
Biomarkers are best used after the diagnosis has been made, according to Balt, when clinicians are faced with a range of treatment options. “A biomarker to determine response to a particular antipsychotic would be quite useful.”
He cited a recent article in Clinical Pharmacology and Therapeutics2 that he coauthored. That paper described specific gene polymorphisms that seem to be more correlated with antipsychotic-associated weight gain.
Researchers at UCSD are seeking to identify the genes associated with schizophrenia and neurophysiologic and neurocognitive biomarkers. In an ongoing study funded by the NIMH, UCSD has joined the Consortium on the Genetics of Schizophrenia (COGS) to learn more about the genetic basis of specific heritable neurocognitive and neurophysiological deficits (called “endophenotypes”) in schizophrenia patients. David Braff, MD, Professor of Psychiatry at UCSD, serves as the study’s national director.
“Maybe at some point down the road—10 to 20 years—we will have a well-validated screening panel. It might consist of a combination of cognitive, EEG, and other neurophysiologic and genomic biomarkers that will guide treatment decisions predictive of outcomes,” Light said.
The NIMH is looking into bio-markers/biosignatures that will predict response to particular depression treatments, according to Jules Asher, an NIMH spokesperson. The goal of the EMBARC (Establishing Moderators/Mediators for a Biosignature of Antidepressant Response in Clinical Care) multicenter study (just getting under way) is to evaluate the usefulness of clinical and biological markers. Antidepressants will be compared with placebo to develop a depression treatment response index to aid clinicians in matching treatments to patients with MDD. (There are more than 20 different medications that have been approved by the FDA for the treatment of depression.)
“The EMBARC study,” NIMH Director Thomas Insel said recently, “is a great example of our new focus on personalized medicine for mental disorders.”