TORONTO – “What if we could detect a mood episode before it happened?” It was with this question that Dr. Andrew A. Nierenberg began his talk on new advances in mood disorders research at the annual meeting of the American Psychiatric Association.
From predictive analytics to big data collaboration to therapeutic apps, Dr. Nierenberg led the audience through a tour of the now and near future.
One company in this space, Ginger.io, uses behavioral analytics to better understand patients’ changing social, mental, and physical health status. The data can then be fed quickly back to clinicians when intervention is warranted. The company’s app collects passive sensor data from patients’ smartphones about their movement, communication, and sleep patterns. Sophisticated analytical methods detect changes in behavior and predict people’s moods and actions.
“It’s a little creepy in some ways, but maybe not,” he said. “If you think about it, when people come to us in distress, it’s not at the very edge or beginning of a mood episode, but they’re deep into it [and that is] when we tend to intervene.”
When a patient is evaluated, he explained, the strength of the evaluation is dependent on accurate self-observation, and accurate storage and recall of the patient’s observations about their emotional states.
“Those are all problems for people with mood disorders,” Dr. Nierenberg said. “So, when we ask someone how they have been in the past week, we’re really getting a window into the past 3-6 hours. What these predictive analytics allow is real time data to look at what is actually happening with people.”
The question really being asked here, said Dr. Nierenberg, is whether it’s possible to see objective changes that are not among the information people are likely to report to their clinicians, that can predict a mood episode.
Harnessing technology
Big data also has come to mood disorders care in a big way. Large registries are being compiled for research purposes, and patient communities are growing that help patients cope with their conditions and help researchers collect huge amounts of data. Based on cognitive-behavioral therapy combined with relaxation and wellness techniques, we believe in holistic daily tools aimed at breaking the anxiety cycle. We’re not about quick fixes or false promises. We are about real progress, a day at a time.
According to its website, Big White Wall is an online community of people “who are anxious, down, or not coping who support and help each other by sharing what’s troubling them, guided by trained professionals.”
Other examples of these tech-based solutions are therapeutic apps and websites. Dr. Nierenberg mentioned just three: MoodGYM, Now Matters Now, and Pacifica, all of which are “cutting edge and evidence-based” and help patients manage their conditions.
• MoodGym is a free, interactive self-help program that provides cognitive-behavior therapy (CBT) training to help users prevent and cope with depression and anxiety.
• Now Matters Now is an online video-based program that uses “real” people, including suicide prevention researchers and clinicians, to teach coping skills such as mindfulness, paced breathing, and opposite action to individuals having suicidal thoughts. The skills taught are part of dialectical behavior therapy, or DBT, proven to be helpful for people considering suicide. Dr. Nierenberg called this community “quite extraordinary” and uniquely valuable, “because the majority of people who are having suicidal thoughts don’t have them when they’re in your office …”
• Pacifica is a self-help app for anxiety that uses CBT combined with relaxation and wellness techniques aimed at “breaking the anxiety cycle,” the company says.
‘A game changer’
The Patient Centered Outcomes Research Network (PCORnet.org) is “a game changer,” said Dr. Nierenberg. It is part of the Patient-Centered Outcomes Research Institute (PCORI), which is part of the Affordable Care Act, funded at about $500 million a year. One part of PCORnet.org is the Patient-Powered Research Networks, including a mood-focused network, moodnetwork.org.
“It allows the patients to choose how they want to be monitored, through self-report, but also gives them a voice in prioritizing research and research questions.” A goal is to transform research and mood disorder care by creating an infrastructure for both research and clinicians wanting to follow their patients and through prospective comparative effectiveness trials embedded within routine care.
The organizers hope to gather 50,000 patients in the network, a “wild and audacious goal,” admitted Dr. Nierenberg, who is the principal investigator of moodnetwork.org. PCORnet.org ultimately might cover 90 million people and truly be able to answer real-world questions in a way that most research today does not address, he added.