From psychedelic research to enhanced diagnostic abilities and developments in supportive technologies, 2022 likely will be recalled as a groundbreaking year in the field of psychiatry. And the timing could not be better.

As the mental healthcare system struggles to meet demand, the need for better and more abundant intervention options has never been more pressing. These seven breakthroughs are poised to help psychiatrists and patients alike in the years to come.

 

Ketamine

Psychedelics had a memorable year in psychiatry. Psychiatric research is increasingly revealing the therapeutic potential of these once-fringe countercultural compounds. But perhaps no drug has had a better year than ketamine, a mainstay of anesthesiology and the rave scene of the 1990s and early 2000s.

A review published in Neuropharmacology in November 2022 found that ketamine shows promising results for reducing suicidality at up to 24 hours after administration compared with its effects on psychosocial functionality, cognition, and anhedonia.

Jawad MY, Di Vincenzo JD, Badulescu S, et al. The therapeutic role of ketamine and esketamine in treating psychopathological domains of depression. Neuropharmacology. 2023;223:109299.

The researchers noted that ketamine’s rapid action is one of its chief advantages for efficacy in instances of suicidality.

 

It seems likely that 2022 won’t be the last time you’ll hear about ketamine. The researchers called for further research of this substance for specific depression domains, noting that evidence is weak in these areas.

 

Pharmacogenetic testing

Imagine taking the guesswork out of selecting an appropriate antidepressant. Pharmacogenetic tests are paving the way toward selecting the optimal drug for each patient.

Pharmacogenetics (also referred to as pharmacogenomics) is an area of research that is shedding light on how genes predispose reactions and responses to specific drugs. Currently, these tests are available for only a handful of drugs.

However, psychiatrists may be pleased to know that several of these tests apply to pharmaceutical mainstays of their armamentarium, such as:

• Antidepressants

• Antipsychotics

• ADD treatments

Evidence is demonstrating the efficacy of pharmacogenetic testing. For example, a meta-analysis published in the Pharmacogenetics Journal in October 2022 found that in patients with major depressive disorder, genotype-supported treatments led to better response and remission rates after 8 and 12 weeks of treatment.

Skryabin V, Rozochkin I, Zastrozhin M, et al. Meta-analysis of pharmacogenetic clinical decision support systems for the treatment of major depressive disorder. Pharmacogenomics J. Published online October 22, 2022.

 

This meta-analysis indicates that the use of preemptive genotyping to guide dosing of antidepressants might increase treatment efficacy.

 

Fluvoxamine to prevent COVID-19 admissions

It’s nice when you don’t have to reinvent the wheel. That was the case this year with the SSRI fluvoxamine, which is commonly used to treat obsessive-compulsive disorder. It turns out that fluvoxamine may have another use: preventing COVID-19 hospitalizations.

A meta-analysis published in JAMA Network Open in April 2022 emvaluated qualifying randomized clinical trial evidence for fluvoxamine in outpatient COVID-19 management.

Lee TC, Vigod S, Bortolussi-Courval É, et al. Fluvoxamine for outpatient management of COVID-19 to prevent hospitalization: A systematic review and meta-analysis. JAMA Netw Open. 2022;5(4):e226269.

 

To be included for consideration, studies had to be placebo-controlled. In total, the researchers evaluated three trials with a total of 2,196 participants. They found that fluvoxamine’s probability of any association with reduced hospitalization ranged from 94.1% to 98.6%. The probability of moderate association ranged from 81.6% to 91.8%.

By comparison, outpatient trials with hydroxychloroquine and ivermectin have not shown any efficacy, and yet these agents continue to be prescribed.

 

Deep brain stimulation

For decades, psychiatric interventions for major depressive disorder have been somewhat confined to psychotherapy, pharmacotherapy, and electroconvulsive therapy. But now, research indicates that an alternative option may be emerging.

Deep brain stimulation involves the surgical implantation of electrodes in specific areas of the brain. Targeted electrical impulses in these areas can affect brain activity, and/or address chemical imbalances.

A study published in Dialogues in Clinical Neuroscience in April 2022 highlighted how this will be an area of research to watch in the years ahead.

Delaloye S, Holtzheimer PE. Deep brain stimulation in the treatment of depression. Dialogues in Clinical Neuroscience. 2014;16(1):83–91.

So far, it’s proven to be preliminarily effective in patients with treatment-resistant depression, and neuroimaging studies are helping researchers understand where to stimulate for desired outcomes.

 

 

Rise of telepsychiatry

Decades from now, telepsychiatry may be something psychiatric students look back on and wonder, “Why didn’t I think of that sooner?” Few technological breakthroughs have so radically altered the practice of psychiatry—and patients appear to like the change.

A study published in the International Journal of Social Psychiatry in January 2022 queried 530 telepsychiatry patients at a university hospital, along with their doctors.

Torales J, Vilallba-Arias J, Bogado JA, et al. Satisfaction with telepsychiatry during the COVID-19 pandemic: Patients’ and psychiatrists’ report from a University Hospital. Int J Soc Psychiatry. Published online January 6, 2022:002076402110707.

Patients and doctors alike were asked to rate their satisfaction with telepsychiatry.

 

On a scale of 1 to 5, the mean ratings for the categories under investigation were:

• Perception of care: 3.04

• Quality of care: 3.03

• Doctor-patient relationship: 2.98

• Confidence in the service: 3.03

Among the doctors, 87.5% were satisfied with the results from telepsychiatry and 87.5% also felt that patient satisfaction levels were acceptable.

 

Brain-gut axis

Research continues to shed light on the brain-gut axis. A 2022 study published in Translational Psychiatry showed some promising results for alleviating symptoms of major depressive disorder.

Schaub AC, Schneider E, Vazquez-Castellanos JF, et al. Clinical, gut microbial and neural effects of a probiotic add-on therapy in depressed patients: A randomized controlled trial. Transl Psychiatry. 2022;12(1):227.

 

The study found that short-term, high-dose probiotic supplements were effective when used as an add-on treatment for depression. In this small study, 21 participants received a probiotic supplement for 31 days in addition to their standard treatment.

Compared with the placebo group of 26 participants, the patients who received the probiotic supplement had scores on the Hamilton Depression Rating scale that decreased over time. The probiotic group also had a lower putamen activation response when viewing neutral faces after receiving the supplements, compared with the control group.

Our results suggest that an add-on probiotic treatment improves depressive symptoms and maintains healthy enterotypes [and] species richness and increases specific health-related bacterial taxa.

 

Artificial intelligence

As the mental healthcare system struggles to meet demand, artificial intelligence (AI) is poised to alleviate some of the administrative burden for psychiatrists and other mental healthcare professionals. A study published in Information Systems Frontiers in May 2022 helped to explain one of the possible ways.

Tutun S, Johnson ME, Ahmed A, et al. An AI-based decision support system for predicting mental health disorders. Inf Syst Front. Published online May 28, 2022.

 

The researchers behind this study developed a clinical decision support system called Psikometrist, a web portal that gathers and saves responses to the SCL-90-R and houses them in a database.

The researchers trained AI and machine learning models to predict mental health disorders, such as depression and anxiety. Psikometrist was able to diagnose mental disorders with 89% accuracy using 28 questions.

Accurate diagnosis for mental disorders through this proposed DSS [decision support system] can reduce the overall healthcare cost due to misdiagnosis, overdiagnosis, and unnecessary treatment.