Jyoti Mishra, PhD, MBA, Neuroscientist, UC San Diego, talks about a new personalized approach to tracking down what’s causing depression.
Interview conducted by Ivanhoe Broadcast News in May 2022.
SO, DEPRESSION SEEMS TO HAVE BECOME AN EPIDEMIC OVER THE PAST FEW YEARS. CAN YOU COMMENT ON THIS TRAJECTORY?
MISHRA: Yes, absolutely. Depression was already common over the last decade. In the 2010’s we were seeing 22 percent mental illness of which depression has the largest national burden, and that number has risen to about 35 percent mental illness now in the 2020s. Recent events such as COVID are absolutely exacerbating how we feel about ourselves, and depression is on the rise, for sure.
DRIVE ME A LITTLE DEEPER, WHAT HAVE YOU SEEN DURING THIS PANDEMIC IN TERMS OF DEPRESSION?
MISHRA: During the pandemic, a lot of research has shown that depression and related mood disorders like anxiety are actually increasing. There is some level of resilience that people have. How long this pandemic has stretched out now, two years or so, it’s really taking a toll on people’s lives.
WHAT CAUSES DEPRESSION?
MISHRA: What causes depression is actually a difficult question because depression can have many different aspects contributing to it. Of course, there are lots of researchers looking at genetics. There are others that are looking at lifestyle and behaviors such as how we sleep, eat, exercise, and then also there is a very important social component as to how we interact with others, how lonely we are, and all of these factors together can decide how depressed the person might feel. So, answering if there is one thing that determines a person’s depression, that will be hard to answer.
HOW IS DEPRESSION TREATED NOW? WHAT SEEMS TO BE THE STANDARD OF CARE OR WHAT HAS BEEN THE STANDARD OF CARE?
MISHRA: The standard first line of care is providing antidepressant medications. And these work on neuromodulator systems in the brain to improve your mood. As you know, medications can have side effects. And some people may or may not respond. So current studies say that actually about 30 to 50 percent of people respond to the standard of care antidepressants that are available. Other than antidepressants there’s also psychotherapy that’s available. There are other brain based treatments such as FDA approved brain stimulation is also available in high-end clinics for severe depression. I’d say that these are the main treatments that are out there.
NOW THE CHALLENGE IS THAT MANY PEOPLE DON’T SEEK HELP OR DON’T EVEN REALIZE THEY HAVE IT. SO HOW DO WE ADDRESS THAT ISSUE?
MISHRA: Yes, indeed. People don’t realize sometimes that they may have it because it’s so subjective. In case of depression, you know, we are taught to always pick up ourselves and keep going. There’s a stigma around mental illness. There’s no little test you could do to say, hey, I’m depressed, that could tell you very objectively about your illness. So, all of these factors do contribute to the fact that people feel a little bit hesitant about going to seek out help. What I’d also add to that is that when people do seek out help from their primary providers, who would then tell them to go see a therapist or consult a psychiatrist, this kind of access is also not very much available. When you need care versus when you get care, that time frame can be actually weeks. In that time frame, a person’s depression can get worse.
SO, YOU’VE DEVELOPED A WAY TO HELP MORE CLEARLY DEFINE DEPRESSION OR DIAGNOSE DEPRESSION. CAN YOU TALK ABOUT THE STRATEGY?
MISHRA: The work that we have been pursuing is really based on the premise that depression really has many different causes. We discussed that there may be genetic and family history contributing to it. There may also be aspects of lifestyle; how we eat, sleep, exercise, and there are aspects related to how we interact with others. So, we wanted to really understand that when a person comes in and says that they’re depressed, what’s going on in their lives? We wanted to take the approach of figuring out all of these different aspects of their life and at the same time not be very burdensome to them, which meant that why not take advantage of tools and technologies that are already out there, which is our phones that we carry around. We also use smartwatches that people wear all the time. Why not take advantage of these so that we can get to know more about how a person is going about their daily lives and how that is contributing to their depression? That’s really the crux of what our approach is based on.
WHAT SPECIFIC SYMPTOMS ARE YOU LOOKING FOR IN THIS TECHNOLOGY?
MISHRA: In our case, the standard is to look at how a person feels because, frankly, that is the gold standard. If you tell me that, you know you’re not feeling well today or you’re feeling a low mood, I would believe you for face value and that’s really the prime thing that we care about, but how that is being determined by various different factors is what we care about even more. So, we are looking at your changes in mood from day to day. So, you don’t just tell me how you’re feeling at this very moment, but when you come in and do this research with us, we’re looking at how you’re feeling from one day to another for up to a month’s period of time. Over this time, while you’re telling us how you feel, we’re also looking at other aspects that I just talked about, like your lifestyle and your interaction with others and so on.
CAN YOU EXPLAIN HOW IT ACTUALLY WORKS FOR PEOPLE? THEY’RE DOWNLOADING THIS APP AND THEY’RE PUTTING INFORMATION IN THIS APP. EXPLAIN HOW THE ACTUAL APPROACH WORKS, STEP BY STEP, BASICALLY.
MISHRA: When people come to see us, or it could also be done remotely, they can download an app which is available on their phones from the app store, and they get a login. It’s a secure login to a system that will then have them report on how they’re feeling three or four times a day. So, it’s a very quick check-in. At the same time, they’re wearing a watch and from the watch, we can get data about how they’re sleeping, how active they are from moment to moment, and also about aspects related to stress that can be gotten from the watch, which are based on heartrate, pulse activity, breath related activity. All of these metrics together feed into a more intelligent understanding of what is determining your mood.
FROM YOUR STUDY, WHAT DID YOU FIND WERE THE PREDICTORS OF MOOD?
MISHRA: So, for us, it was actually very fascinating because we followed a path of what is non-traditional research. In traditional research, one would say that we would collect data from many different individuals, even thousands of individuals, and compare different individuals with one another, say depressed versus not depressed and how as an aggregate does the depressed individual look from the non-depressed individual? So that is very aggregate understanding and that is the standard for the field. That really doesn’t give you personalized insight into how a given person may be feeling. To tap into that, we said, let’s look at some machine learning and artificial intelligence approaches where we can treat each person as unique. So, what we did was take each person’s data alone and only use their data to predict how their depression evolves or the way that they feel happy or sad changes over a month-long period of time. Over that time, there are all of these other factors that might be determining how you’re feeling. We can model that with these AI and machine learning approaches. What we found was actually very fascinating and what it led to was that we can start to understand depression in a more personalized way. For one person, we would observe how they slept, consistently or inconsistently determining their depression and for the very next person, we would see aspects of how active they were. For a third person, it might be stress related and how mindful their breathing activity was. So given the person, their specific predictors could be very different. That’s essentially the approach that we developed to figure out that when a new person comes in with a problem such as depression that can be very complex, how do we target the processes that really precisely determine their depression? So, when you ask what the predictors are, there can be many predictors actually from person to person, but our techniques were able to get at what determines a given person’s depression.
WHAT ARE THE NEXT STEPS NOW THAT YOU HAVE THESE INITIAL RESULTS?
MISHRA: We’re actually very excited about the next steps. Our work to-date has built these AI and machine learning algorithms using data from apps, using data from wearables, of course, all securely collected, and that can give us a personalized understanding of what a person’s depression may be caused by. Of course, all of these models are still based on correlated data, which means that we haven’t changed their underlying factors in any way. So, if I were to observe that a person’s depression is determined by their sleep, then in the next phase, what we’re going to do is provide that person evidence-based sleep treatment, and another person might get evidence-based physical activity training and so on. So, unlike traditional research where people may be looking at sleep as a specific treatment and everybody will get that treatment, or exercise as a specific treatment that everybody gets, here, everybody coming to us will actually get the exact treatment that they need, and it’ll be different for each person. So that is a trial that we actually just launched. We’re very excited to see whether targeting these precise markers of an individual’s mood and their depression can actually lead to better outcomes than have been shown by current standard of care.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Michelle Brubaker
(858) 249-0416
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
