A blood test may help the diagnosis and treatment of depression

https://www.economist.com/science-and-technology/2021/05/03/a-blood-test-may-help-the-diagnosis-and-treatment-of-depression

by eciffo • 5 years ago

90 53 5 years ago

economist.com

david-gpu• 5 years ago

https://archive.is/r5lZi

tppiotrowski• 5 years ago

More information and publication biography on the company's website. [1]

I'm not sure if I read this correctly, but part of their approach is to take biomarkers from suicide victims

  The validation step 3 is usually done in an independent cohort of clinically severe subjects (or, in the case of suicide, a cohort of suicide completers).

[1] https://mindxsciences.com/faq/

aritmo• 5 years ago

Oh, it is that bad... Terrible.

Y_Y• 5 years ago

They should really use the perpetrators rather than the victims.

podgaj11• 5 years ago

No, this was done with living subjects.

Blikkentrekker7• 5 years ago

Depression’s diagnosis has, though, a worryingly arbitrary quality to it, depending as it does on a doctor’s assessment of a patient’s mood against a checklist of symptoms which may be present in different combinations and are often, in any case, subjective. This has led to a search for reliable biochemical markers of the illness. Not only might these assist diagnosis, they may also improve assessments of prognosis and point towards the most effective treatment in a particular case. Now, a group of neuroscientists at Indiana University, in Indianapolis, led by Alexander Niculescu, think they have found a set of markers that can do all this.

Such markers have long existed and been found. This wording suggests that this is the first attempt.

The markers are always only correlative, and obviously it won't happen that, if a patient show the markers, but otherwise show no subjective, he'll be diagnosed with depression, or vice versā, denied such a diagnosis, if he show the symptoms, but not the markers.

Together, these 13 RNA markers form the basis of a blood test that can not only diagnose depression,

“diagnose”? I doubt that it will replace subjective diagnosis for the aforementioned reason. — the subjective diagnosis will remain the final judgement for a time long to come.

neuroma• 5 years ago

Agreed. Many psychiatric disorders are a function of personal experience and of collective experience of the person. Whilst I'd welcome more objective and quantitative assessment tools, it feels like blood tests won't ever tell you if a person is depressed. They might suggest a level of inflammation or endocrine stress, and that's a great help, but not equivalent.

bawolff2• 5 years ago

Many psychiatric disorders are a function of personal experience and of collective experience of the person

[Citation needed]

That seems like a bold claim relative to our current level of understanding.

tsimionescu6• 5 years ago

If these blood tests do end up being good predictors of depression, it will be very interesting to see how they apply to people who are suffering from similar symptoms that are not clinically depressed - for example, people who have just experienced the death of a loved one.

satellite2• 5 years ago

There was actually an exeption for people that lost someone in the DSM. Following long debates they ended up removing it.

What seems clear is that in a lot of cases depression seems to be a normal reaction to worsening life conditions and not merely a brain chemicals imbalance. So I think it's wise to remain careful around what can be considered a depression and whether it should be considered a symptom or a disease.

https://www.theguardian.com/society/2018/jan/07/is-everythin...

podgaj11• 5 years ago

This is what worries me.

I would say that they need to do an RNA test and a Genetic Test as well.

I have Bipolar Disorder and even I go through periods of remission. Looking at genetics might give a better clue about how the trauma may effect a person long term.

They really need to figure out how to test for these catecholamines in the brain...

pdamoc• 5 years ago

“Correlation doesn’t imply causation, but it does waggle its eyebrows suggestively and gesture furtively while mouthing ‘look over there.’” - Randall Munroe

The way I see this is that it might be one of those tests that, if they come back positive, indicate that further analysis should be made. A general practitioner might ask for this test and then recommend to the person to see a specialist.

Blikkentrekker7• 5 years ago

Well, as said, the article suggests that this is a novel approach, but similar markers have been known to exist for a while and they still aren't used in diagnosis simply because they're typically not more indicative than simply the patient verbally enunciating “I feel bad.”.

scotty79• 5 years ago

There's a saying that "you don't treat test results". Tests always just inform a diagnosis and usually are not even performed if patient is not suffering any symptoms.

strken• 5 years ago

If it's an RNA test, doesn't that mean it's just testing for the genetic predisposition? Unless depression is wholly genetic it seems weird to use an RNA test to diagnose it.

Edit: forgot my biology, testing for levels of RNA is probably pretty close to testing protein production.

colechristensen4• 5 years ago

A problem with modern psychology is the diagnostic criteria aren't very much based on underlying causes as on being able to reliably diagnose patients based on symptoms regardless of physician. This leads to people agreeing what your diagnosis is without a strong or particularly useful set of understanding of what caused it or a specific treatment to change those causes (which is why so many people are on SSRIs). Historically there just wasn't much to go on when it came to determining underlying causes but neuroscience is catching up with understanding much more about how brains actually work.

The point is "depression" or "PTSD" probably don't exist among many others. There are perhaps dozens or hundreds of unique conditions currently lumped together because they present in vaguely similar ways - the good news is that we are making progress towards much more arguably "real" understandings, the bad news is we're still quite far away from diagnosing mental conditions with the same specificity we can diagnose cancers or viruses.

dragonwriter• 5 years ago

A problem with modern psychology is the diagnostic criteria aren't very much based on underlying causes as on being able to reliably diagnose patients based on symptoms regardless of physician.

That’s generally true of diagnosis when we don’t understand the mechanism, and since where we do understand the mechanism we treat that as a reason to move the thing-with-behavioral-symptoms out of psychology and into some other medical domain, so its essentially an irreducible problem with psychology.

mjevans• 5 years ago

A diagnostician which crosses all specialties would be really nice. I imagine this is an area where an easily replicated computing tool might be the best advancement in the field. Initial symptoms and the low hanging easy tests (as well as any others 'that may as well also be run' for any labs or test types indicated given a moderate extra effort) would drive a root cause diagnosis and recommendation for a specialist who can best treat any of the possibly multiple issues.

Blikkentrekker7• 5 years ago

The point is "depression" or "PTSD" probably don't exist among many others. There are perhaps dozens or hundreds of unique conditions currently lumped together because they present in vaguely similar ways - the good news is that we are making progress towards much more arguably "real" understandings, the bad news is we're still quite far away from diagnosing mental conditions with the same specificity we can diagnose cancers or viruses.

One sees this in a bizarre number of fields, that specialists act as though the classifications actually be as rigid and objective as in, say, physics, and that something objectively is or is not something, and then debate it.

I've actually read some debates between linguistics that are quite passionately debating whether something is an allophone of the same phoneme, or a different phoneme altogether, and I do not find such distinctions to be all that objective as the language they used suggests.

colechristensen4• 5 years ago

Name magic.

To know a thing's name is to have power over it.

From ancient mythos to modern specialists and especially philosophy, naming things gets a whole lot of focus. It does because it is terrifically useful! Naming, separating, making distinctions, this is an essential part of understanding.

However a whole lot of these kinds of debates don't acknowledge what kind of a debate they are actually happening. Is the subject of debate the limits of where a definition matches and were it doesn't? Is it whether the subject fits within already agreed limits? Is it really about an unspoken assumption that differs between the parties arguing? Many also don't address the quality of the definition. Is it a useful definition that represents defensible differences between "has this name" and "doesn't have this name" or is it an entirely arbitrary classification (say, look at the color spectrum and define areas which are red and which are orange; now zoom in on a boundary between the two, is there any defensible reason why the border should not be moved slightly to add one color to red? No, probably not)

I've actually read some debates between linguistics that are quite passionately debating whether something is an allophone of the same phoneme

In this example are they really arguing about the something in question or are they arguing about the definition of "allophone" without realizing it. The followup question is "what is the reason why this edge case is relevant?" and "if this edge case isn't relevant, is the term 'allophone' even useful?"

wittyreference• 5 years ago

A problem with modern psychology is the diagnostic criteria aren't very much based on underlying causes as on being able to reliably diagnose patients based on symptoms regardless of physician. This leads to people agreeing what your diagnosis is

That is true. The groupings persist because they are useful in facilitating communication regarding potential complications, prognosis, and patterns of response to treatments.

People seem intent on throwing away the above utility with a backhanded “but that’s not the Real Diagnosis.” It’s not, but within the limitations of our current understanding of neurology, it’s the best we have come up with so far (allowing for some limitations due to the pace of spread of innovations, politicking, etc.)

maybelsyrup• 5 years ago

Clinician and researcher in mental health here. In my view, you're being too charitable.

The groupings persist because they are useful in facilitating communication regarding potential complications, prognosis, and patterns of response to treatments.

These are reasons, but they're a distant second. Mainly, they persist because those groupings - diagnoses, in other words - have become necessary for billing. The DSM, for instance, is an economic document, not a scientific one. For most people, it sits on a shelf, gathering dust.

As for "the best we've come up with so far", you'd perhaps be interested to learn how often the decisions about these groupings are made because of politics and economics, and not by science [1].

[1] https://www.amazon.com/They-Youre-Crazy-Paula-Caplan/dp/0201...

testfoobar• 5 years ago

In the majority of US States, psychologists cannot prescribe medications.

https://www.verywellmind.com/can-psychologists-prescribe-med...

drknownuffin• 5 years ago

These conversations tend to conflate psychology and psychiatry. Which isn't altogether unreasonable.

colechristensen4• 5 years ago

I would have used a more generic term to include both if I knew one. Psyche-related healthcare providers and the science behind them? Meh.

AnthonBerg• 5 years ago

I’m fairly sure that this paper is the one alluded to in the original press release:

Le-Niculescu, H., Roseberry, K., Gill, S.S. et al.

Precision medicine for mood disorders: objective assessment, risk prediction, pharmacogenomics, and repurposed drugs.

Mol Psychiatry (2021)

https://doi.org/10.1038/s41380-021-01061-w

podgaj11• 5 years ago

Here is the study:

https://www.nature.com/articles/s41380-021-01061-w

I have my genetics through 23andme and I have Bipolar Disorder. The one thing that stuck out at my in my genetics were my SNPs in SLC6A4, which is one of the markers they look at.

A blood test may help the diagnosis and treatment of depression

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