.jpg?sfvrsn=8da4d154_1 "Max Wintermark, Chair of the Department of Radiology at the UTMB John Sealy School of Medicine (JSSOM)")
A collaborative team of researchers from The University of Texas Medical Branch (UTMB) and Stanford University has published an article in Nature Mental Health about their effort to use MRI to inform treatment choices for patients with depression.
A depression diagnosis is often the beginning of a trial-and-error treatment process that can have serious implications for a patient's health, personal and social relationships, career, and financial stability.
“Psychiatrists do their best to pick the treatment they think would work well for a given patient,” said Max Wintermark, MD, MS, MBA, senior author of the study and chair of the Department of Radiology at the UTMB John Sealy School of Medicine. “But typically, the first time around, the likelihood of that treatment working is about 30%.”
The study’s co-authors include Leanne Williams, PhD, and Lara Foland-Ross, PhD, of Stanford University.
Cycling through the available medication can take months, even years, during which patients must deal with the consequences of their illness. Wintermark said some patients may lose their jobs, experience homelessness or addiction, or die by suicide before they experience symptom relief.
By using MRI to assess the function of different brain networks, researchers were able to make more informed treatment decisions. In the study, about two-thirds of patients responded to the first medication prescribed.
Wintermark compared the process to choosing cancer treatments, where clinicians gather bloodwork, images, and other data to guide their decisions. Oncologists seek as much data as possible to inform those treatment choices.
“I think we're finally getting to that stage for mental health,” Wintermark said. “And it's particularly well aligned with UTMB priorities around brain health and brain economics.”
The journal article also announces the establishment of the Precision Mental Health Commission, which will bring together a multidisciplinary, cross-sector, globally representative group of international leaders spanning neuroscience, clinical medicine, health systems, health technology, and public policy to define a new era of precision mental healthcare.
Commission members will be selected based on their leadership in advancing innovative approaches to research and care and will represent a range of disciplines and career stages, from established leaders to emerging investigators. The Commission will include representatives from academia, international organizations, governments, health systems, patient advocacy groups, philanthropic organizations, and industry.
The commission will work toward an actionable framework that establishes brain circuits as the central organizing axis for precision mental health, linking measurement to stratification, treatment selection, and clinical implementation. The commission aims to propose a precise, effective, personalized model of mental health care to substantially improve outcomes for individuals worldwide.
“One of the things I hope to accomplish is to implement this method at UTMB, in collaboration with psychiatry, and then offer that approach to the patients in the larger Houston-Galveston area,” Wintermark said.
According to the journal article, mental health disorders remain among the most pressing public health challenges worldwide. Depression alone affects more than 280 million people globally and is the leading cause of years lived with disability, with an estimated economic burden exceeding $1 trillion each year.
Mental illness also increases the risk and severity of other chronic conditions, including cardiovascular disease, diabetes, and cancer.
Because many mental health conditions begin early in life and can take years to diagnose, their effects often accumulate over decades, shaping long-term health, education, employment, and life expectancy. Finding an effective treatment for depression takes about seven years.
“From a symptom perspective, patients with depression have the same symptoms, so it's really hard to determine the underlying mechanism,” Wintermark said. “But using a functional MRI approach, you can identify that mechanism, or underlying biotype.”
Wintermark provided the imaging expertise for this precision medicine approach.
“I really want to acknowledge my colleague at Stanford in the Department of Psychiatry, Dr. Leanne Williams,” Wintermark said. “She has really been the driving force behind this initiative, and we have collaborated for the past 15 years.”