Emerging Research and Technology: Beyond One-Size-Fits-All Medicine

At the recent NEI Congress in Colorado Springs, Colorado, Vladimir Maletic, MD, MS, clinical professor of psychiatry and behavioral science at the University of South Carolina School of Medicine in Greenville, examined how new research and emerging technologies show promise for advancing clinicians' comprehension of brain networks, circuits, and neurotransmitters. In this interview, Dr Maletic emphasizes how this "better understanding of underlying pathophysiology may lead to better-integrated treatments, which will provide us with better results sooner," and how it has the opportunity to benefit those with neurological and psychiatric disorders. 

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Read the Transcript: 

Psychiatry and Behavioral Health Learning Network: Which emerging research or technologies show promise for advancing our comprehension of brain networks, circuits, and neurotransmitters to benefit those with neurological and psychiatric disorders?

Dr Vladimir Maletic: There are several large scale projects; I will mention one by name. It is an ENIGMA project. It is a project that literally involves hundreds of thousands of patients from a variety of different psychiatric conditions. What is the idea behind ENIGMA? Let us have a more comprehensive understanding of psychiatric disorders.

We have a genetic component of this research with large genome-wide association studies, again informing us about underlying genetics of psychiatric conditions. How are they similar, how are they different? How do they combine with each other? How do they interact with life adversities?

The other part is an imaging component, and this is both functional and structural imaging. There is information that comes from brain banks. So we can now look at cytology and the difference in cell composition in various psychiatric conditions. And then lastly, we can provide cross-referencing. So for example, in individuals who have major depressive disorder, we can look at how are they genetically different from healthy controls, but also how they're genetically different from other psychiatric conditions.

And what genetic risk for other psychiatric conditions may contribute in terms of the manifestation of major depressive disorder. We can look at the pattern of difference in activity of brain networks that are functioning, but also their structure. 

Once we understand what the difference is between individuals who are depressed and individuals who are not depressed in terms of certain brain areas, we can then use the postmortem studies. We can use information derived from brain banks and look at what is the cellular composition in these implicated brain areas that differentiates individuals who have this mood disorder from ones who do not. So we have an immensely complex issue in understanding pathophysiology of this condition and it requires immensely complex tools. And now we are utilizing these tools and we'll probably have much better understanding of what goes on.

Why is that important? Because, I believe, that ultimately future in treating psychiatric conditions is not having one best medicine, but being able to compose the most effective integrated approach.

How are we going to integrate psychotherapy with dietary interventions, with psychotherapies, with meditation, with exercise, and nutritional interventions? How can we combine these with neuromodulatory treatments when it is necessary? How can we potentially combine them with psychedelic agents or GABA glutamate modulating agents so that we have a sensible approach that will be abbreviated so our patients don't have to go through years of suffering before through trial and error, we come up with some formula that may be able to help them?

This global better understanding of underlying pathophysiology may lead to better integrated treatments, more rationally integrated treatments, which will provide us with better results sooner. 

In closing, I'm Vlad Maletic, and I really appreciate your time in joining us on this occasion. And I hope that this conversation, I wish it was more of a dialogue, will be helpful to you and ultimately will be helping you help your patients.

Vladimir Maletic, MD, MS, is a clinical professor of psychiatry and behavioral science at the University of South Carolina School of Medicine in Greenville, and a consulting associate in the Division of Child and Adolescent Psychiatry, Department of Psychiatry, at Duke University in Durham, North Carolina. Dr Maletic is a member of several professional organizations, including the Southern Psychiatric Association and The American College of Psychiatrists. In 2013-2014 he served as a program chair for the US Psychiatric and Mental Health Congress. His special areas of interest include the neurobiology of mood disorders, schizophrenia, pain, and the regulation of sleep and wakefulness. Dr Maletic is board-certified in psychiatry and neurology.