The Long Road is a three-part series that covers different perspectives on the human toll of today’s trial-and-error approach to mental health diagnosis and treatment
For Dr. Andrew Bishop, solving the mental health crisis is deeply personal.
“My interest in psychiatry started early in life,” Dr. Bishop said. “My mother had anxiety, was majorly depressed and had panic disorder. She eventually remitted when I was 18 years old, but a lasting mark had been made on the both of us.”
Dr. Bishop, a psychiatrist and founder of a large private practice in Jackson, MS, sees firsthand the toll taken on patients and families when they experience a delay in finding the right medications.For people struggling with mental health conditions, time is of the essence.
“I see patients coming into my office everyday who have been suffering for one, two, three years sometimes, having gone through trial after trial of failed medications, often losing hope,” Dr. Bishop said. Only one-third of patients with depression receive the medication they need on the first try. The longer it takes, the greater the pain, and the higher the risk that patients stop seeking help altogether.
A Matter of Trial-and-error
In some respects, treating patients is an educated guessing game that centers primarily on guidance from the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), a handbook widely used by clinicians and psychiatrists to diagnose psychiatric illnesses. The DSM was first published in 1952 and remains the professional standard for diagnosing all categories of mental health disorders for both adults and children.
In this age of rapid technological advancements in other areas of medicine, the lack of objective testing can leave even the most seasoned mental health professionals feeling frustrated. Existing tools and approaches are inadequate to quickly provide people the help they need.
“We had been taking broad inferences from our literature and applying them to specific patients, because that’s been the standard of care,” Dr. Bishop said. “These interventions are often without reference to the underlying biology of the illness, and when the drugs prescribed do work, improvements seem almost random in their response.”
Advancing Precision Psychiatry Together
Dr. Bishop’s approach changed in 2019 after he encountered a talk given by Dr. Amit Etkin, founder and CEO of AltoNeuroscience, who discussed his transdiagnostic and brain circuit-based approaches to treating mental illness.
“He’s been doing what I've been trying to do all of these years, but he’s doing it with better technology and tools, and the expertise to execute,” Dr. Bishop said. “I thought, I have to get in touch with him.”
He reached out to Alto and was invited to participate in a clinical study the company was conducting, collecting data that will help advance the Alto’s precision psychiatry approach. They have been working together ever since.
“The experience hasn’t been hierarchical, where we just take the bench and shoehorn it into clinical use somewhere. It’s been more of a dance. We inform each other. Our common language is neuroscience.”
Dr. Bishop is confident his work with Alto will provide clinicians with a significant boost in the battle against mental illness, by reducing the time it takes to match patients with the right therapeutics. “Our research will change the way drugs are conceived and prescribed,” he said.
“The future is a transdiagnostic, circuit-forward approach, and it is measurement based.”
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