MQ-funded researcher Claire Gillan and her team are developing a tool to help GPs make more personalised treatment choices for people with mental illness - cutting out trial-and-error once and for all. We spoke to Claire about this ambitious project - and why she’s looking to pharmacists for help.
Hi Claire! Could you start by explaining what your research looks at?
Of course. My work focusses on understanding what causes mental health problems - and using this information to improve treatment, detect mental illness early and potentially intervene before a mental illness gets firmly established.
I study how the brain processes information and learns from experience, and how this can make people vulnerable to different mental health issues. For example, some of my past work found that people with a tendency to form automatic habitual responses, supported by a specific network of brain regions, could be at risk of developing OCD, addiction and a host of other problems related to 'compulsivity'.
And what’s the current project you’re working on?
For this project, we want to use some of these learnings to develop a tool that can help GPs make more personalised and effective treatment plans for patients. To do this, we hope to follow 1,000 people from all over the world who are starting a new course of antidepressants. We’ll follow them during their first few weeks of taking the medication, asking them to complete brief questions on their experience of the treatment.
Before treatment, we’ll measure some basic brain processes, along with an array of information relating to factors like family history, early life events and physical health. We will then follow them to find out who has a positive response to the antidepressants and who doesn’t. This information will help us to "train" a computer algorithm that can find patients who are destined to have a good response to this treatment.
If it works, the idea is that - before new patients walk through the door of the doctor’s office - they can complete a brief assessment on their computer, and the doctor can use this algorithm to predict how likely they are to respond well to treatment, before they take it.
What do you think is causing a lack of precision when prescribing antidepressants? Why is the process still trial-and-error?
That’s a great question. I think one of the reasons is that, at the moment, the prescription of antidepressants is largely based on things called diagnostic categories. For example, if you have depression or OCD, antidepressants are automatically considered as the first option. And it’s true - of all the drugs we have, antidepressants do work best for these conditions, on average. But the problem is that not all patients with depression are alike, while some patients get better, lots of patients don’t benefit from these drugs.
A growing body of work demonstrates that there’s a huge amount of variation among people with the same diagnosis. This isn’t just in their response to treatment, but in their neurobiological profile, their family history, and their exposure to stress and early adversity.
We think it may be possible, with the help of artificial intelligence, to use this complex web of information to make individualised treatment plans, rather than just giving someone a treatment plan based on their diagnosis. This personalised approach would help us avoid prolonging someone’s illness with a medication that doesn’t help, or increasing the chances they give up on treatment altogether.
Why are you looking for pharmacists to help your project develop?
In the past, we've had lots of success finding patients who are willing to help. People with experience of mental illness are amongst the most generous with their time and enthusiasm for research. But an enormous challenge we face is communicating our study to potential participants at the right time- when they are about to start taking a new course of antidepressants.
This is where pharmacists can be of enormous help. They are present when a person receives their prescription for antidepressants - at the very moment we need their assistance for our study.
We’ve launched a global campaign to ask pharmacists to help us carry out this important research. We have had a great response so far, but need many more people to reach our ambitious goal of 1,000 patients for this study
How can pharmacists get involved?
It’s really simple - to take part, pharmacists can sign up on our website. We will then send information about the study and fliers to their place of work, which they can pass out to anyone filling an antidepressant prescription at their pharmacy.
What are your hopes for what this project could achieve?
If the project is successful, we believe we will be able to provide patients and GPs with a basic tool that they can use to prescribe antidepressants more effectively - and only to people who they will work for. Others could be fast-tracked to behavioural therapies or alternative medication strategies.
In mental health, time is too often critical - getting patients better, faster has to be a key objective.
Last updated: 9 January 2019