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When the lifestyle of an entire society changes, it makes sense to think of solutions that fit this new reality. In psychiatry, the most talked about novelties usually refer to drug technology - as substances that take less time to bring the desired stability, cause fewer side effects, etc. However, there are other possibilities that may be just as necessary.
Among the new features, scientists from all over the world are studying biomarkers that enable the development of drugs for increasingly specific health conditions. In addition, in the last decade, several applications and other technologies have been developed to help optimize patient treatment, in addition to tracking signs that accelerate diagnosis and initiation of treatment.
Why does psychiatry need to innovate?
In mental health, as in everything related to health, there are no solutions that meet All the people. Although a group may share the same diagnosis, the way in which each body responds to treatment is often different. As an example, a multicenter observational study conducted by the Federal University of Minas Gerais (UFMG), conducted in 2019 with 1,475 participants, estimated that 30% to 40% of patients with depression in Latin America did not respond to medications.
In other words, the discovery of new biomarkers may help to develop more assertive medications for these people. However, it's also possible that they need different approaches to treatment - and that's where new technologies come in.
The possibilities of new strategies for maintaining or restoring mental well-being are now directly linked to smartphones and Internet access.
This is because smartphones are already part of most people's reality and represent a dichotomous potential: at the same time that the excessive use of these devices is associated with a higher incidence of mental disorders - especially due to social networks - it is possible to use this already widespread technology to promote mental well-being, improve treatment adherence and track symptoms. Therefore, it is worth considering the following data:
- 78% of the world's population over the age of ten has a cell phone (Source: UN).
- And 67% have Internet access (Source: UN).
- Around 249 million smartphones were in use in Brazil in 2023, equivalent to 1.2 cell phones per inhabitant. (Source: FGV).
On the other hand, what 'smartphones' have brought to people's mental health - especially young people - is:
- 39% of social network users consider themselves addicted to them (Source: Forbes/Statista).
- 67% of teenagers say they feel worse about their lives due to the use of social networks (Source: Forbes/Healio);
- In parallel, 73% find solace for such issues through the same platforms (Source: Forbes/Healio);
- Adolescents who use social networks for more than 3 hours a day are more likely to internalize problems (Source: Forbes/Jama Psychiatry).
It was by considering information like this that mental health specialists joined technology specialists.
Mental health technologies
15,000 health apps. This was the number identified by a study carried out by the World Health Organization (WHO) in 2015. Of those, 29% of the apps focused on mental health. Popular among them are Calm and Headspace — focused on guided meditation and mindfulness — and Cíngulo, which focuses on guided therapy, an approach that helps users deal with anxiety, stress, insecurity, and others.
In general, apps aimed at mental health are a good alternative for those who want to know themselves better, since they help to monitor habits and changes in mood, in addition to learning about strategies that help maintain mental well-being.
According to the integrative review “Use of a mobile app for mental health care in an academic environment”, published in JRG Journal of Academic Studies, university students are more open to using apps aimed at mental health. In the words of the researchers, “the development of mobile health apps has increased exponentially, and the use of apps has been reported to improve the efficiency of health care delivery and the effectiveness of treatment (Na et al., 2022)”.
In addition, the analysis of the study shows that the mHealth sector (which encompasses cell phone applications and wearables) has been growing more and more in recent years. Putting this potential into numbers, a survey by Global Market Insights (GMI) indicates that the mHealth market was valued at around US $111 billion and should show an annual growth of 22% by 2032 — year in which it should already generate around 888 billion dollars.
To arrive at such a projection, the analysis took into account the growth of digital health services for patient monitoring, as well as the promotion of these technologies by large government institutions and other characteristics, such as:
- Increase in mobile phone and Internet penetration - in this sense, the 2023 report “The Mobile Economy” points out that, by 2030, 92% of the world's people must have a smartphone.
- Increased incidence of chronic diseases;
- Great cost savings in the provision of health care;
- Growing adoption of wearable smart medical devices.
Another point worth considering is that 2024 analysis of the report “The Mobile Economy”, shows that the use of smartphones to improve and/or monitor health increased from 15% in 2015 to 21% between 2016 and 2022, reaching 2 billion users.
But after all, what is special about these technologies?
Apps and Wearables
To understand why technologies are used in mental health treatments, the forensic psychiatrist and managing partner of Ethos Psiquiatria, Thiago Fernando, explains that “several studies show that there really is a large part of the world's population that uses smartphones and patients with psychiatric disorders use them a lot, so it's one of the possibilities we would have, to use data from both smartphones and wearable devices - such as smartwatches and the like”.
Within this, there is digital phenotyping. As stated in the study “Digital phenotyping and personality disorders: a necessary relationship in the digital age”, available on the Latin American network of Psychology Journals (PepSIC), the term “refers to the in-situ quantification of the human phenotype, using personal data from digital devices”.
That is, digital phenotyping is about monitoring symptoms and other physiological signs. “We were able to monitor anxiety symptoms by scales, so the patient opens the app and adds different aspects related to anxiety to the scales, generating a score,” says the psychiatrist. Among other possibilities, “there is also a way to monitor with GPS or accelerometer data to measure that patient's activity, which allows us to estimate fatigue or tiredness. This is digital phenotyping and it is a resource with the potential to add to the analysis of for a diagnosis”, adds Thiago Fernando.
Going beyond physiological signs, some technologies consist of offering patient care chatbots, this solution has been designed for people with suicidal ideation and/or behavior. However, despite the great potential, “these technologies are not yet really prepared for this type of situation, we still have a lot of studies in progress to show the effectiveness of this treatment”, explains Thiago.
On the other hand, the Otsuka America Pharmaceutical And the Click Therapeutics teamed up to develop technologies such as the app Rejoyn, which is one of the first apps approved by the American health regulatory agency, Food and Drug Administration (FDA).
The solution is designed for patients being treated for major depressive disorder and can only be used with a doctor's prescription, for adults aged 22 and over. The proposal is to provide cognitive training and therapeutic guidelines for major depression. Within the gold standard, the Rejoyn it is used together with medications and advice from professionals.
Still in line with digital, the creators of Rejoyn they are also developing tools for patients with chronic insomnia. The digital watch called “nightwork” helps treat nightmares caused by post-traumatic stress disorder.
“[The watch] monitors the patient's physiological experience while they are sleeping and identifies when that subject begins to have nightmares or disturbing dreams. When this happens, it sends some vibrations to wake the patient up, so it works as an adjunct to the treatment and ends up being a very very interesting possibility,” says the managing partner of Ethos Psiquiatria.
Therefore, in general, apps and wearables fulfill the function of guiding the patient on their healing journey, which is usually done by mapping behaviors, signs, and symptoms.
Computational Psychiatry
One of the challenges of psychiatry is the difficulty of quantifying the impact of each symptom. How much cognitive decline occurred in one patient? How much distress is he feeling? Questions like these can now be answered through computational psychiatry.
To better understand this issue, we interviewed one of the pioneers in this segment: the psychiatrist, neuroscientist, researcher, and chief scientist of Mobile Brain, Natália Bezerra Mota, who was nominated and won several awards around the world, in addition to being cited by magazines Forbes and Nature as one of the “20 most powerful women in Brazil”.
Computational psychiatry consists of analyses of the complexity of speech, with the purpose of tracking and following up signs of mental distress, cognitive and learning development or decline, in addition to the investigation of dream reports and electrophysiological correlates.
For example, imagine detecting whether a patient will be diagnosed with bipolar disorder or schizophrenia at the very first psychotic outbreak. Computational psychiatry allows this effect. However, at this time, the researcher's attention is on optimizing this technology to monitor the cognitive development of children and adolescents, in a style similar to what is done in prenatal care, for example.
“Mobile Brain's first product is LitMetrix and focuses on schooling,” says Natália. It works as follows: with a set of metrics based on stories told by students, LitMetrix monitors the complexity of children's narrative. Thus, it is possible to predict whether the development of speech, reading, imagination, and reasoning is in line with what is expected for each age.
At first glance, technology seems to be aimed solely at education. However, “adequate cognitive development at the beginning of life is one of the elements that preserves mental health throughout life, in addition to slowing down the process of cognitive decline at the end of life”, as explained by the expert.
Embedded in this is the startup's second product: Cognix, a resource that also performs natural language processing, but considers the emotional expression generated from the visualization of images.
All of this is the result of perceptions that Natália had during her period of residency in psychopathology: “At the time I was studying psychopathology, a record fell out: we have other aspects that are not the content of the speech, but are related to shape how do we talk. These are characteristics that generate a lot of description of symptoms,” says Natália.
As an example, she says: “For example, I was struck by the difference between psychosis that has a worse prognosis, which is non-affective psychosis (known as schizophrenia) where a person has a very intense cognitive decline very early and ends up losing social contact, in addition to various communication skills. It is very different from other psychoses, in this case those that have other outcomes, such as bipolar disorder, which can be transient and what actually happens is a fluctuation in mood, which has less impact on cognition and allows for easier rehabilitation. In other words, it is easier for her to reintegrate into society. On the other hand, it is easier for people who were diagnosed with schizophrenia very early to stop studying.”
The study “Mental mapping through computational discourse analysis”, carried out by Natalia Bezerra Mota in 2017, is available hereto.
The discovery of new biomarkers
Technologies have great potential, but they should not yet become protagonists of treatments. For the future, the discovery of biomarkers and different biotypes within the same disease may allow the development of more assertive drugs.
In this field, one of the main novelties relates to a study recently published in the journal Nature Medicine. The research”Personalized brain circuit scores identify clinically distinct biotypes in depression and anxiety”, detected different brain circuits, which allowed the participants to be divided into six different types of depression and anxiety.
In addition, there are other studies that have made relevant discoveries in recent years. For example, as published on the “Progress In Mind” portal — from Brazil Psychiatry & Neurology Resource Center —, increased prefrontal glutamine is an indication of the onset of phases in anxiety and mood disorders.
Neurorights
Finally, all these news are a way of renewing hope for the cure of mental disorders. However, the technological part brings with it a new fear: the issue of Neurorights.
Neurorights refer to a set of ethical and legal principles that aim to protect the integrity and privacy of the human brain in the face of advances in neuroscience and neurotechnologies. In general, the idea is to ensure that the new tools are used ethically and responsibly, without infringing on people's fundamental rights. But, after all, what would lie at the core of these fundamental rights?
In this regard, we can divide it into two main fields: the data breach that can generate discrimination and the one that can generate interferences with thinking and/or lifestyle. In force since August 2021, the General Data Protection Act (LGPD) already brings to the spotlight how this data can be used to discriminate candidates in selection processes and other decisions in the labor market.
However, the concern of Emi Mori - forensic psychiatrist and managing partner of Ethos Psiquiatria - is different: “When we talk about mental privacy, there is the cerebral part, but there is also the conscious part. Brain and consciousness are not synonymous. We need a whole brain, without any type of injury, without any functional alteration, so that our consciousness can manifest itself. When we speak of conscience, we are referring to our wishes, opinions, and desires. All of this is a demonstration,” he explains.
In other words, the fear is about excessive interference with consciousness. Therefore, the issue is further complicated by the increasing sophistication of neurotechnology. Mori notes that while we can't yet accurately map how different parts of the brain correspond to specific emotions or thoughts, the possibility of accessing brain data raises significant concerns about mental privacy.
“We still don't have an exact understanding of how these brain areas manifest and how neurotechnology can access that information,” she says.
Embedded in these issues, the interaction between consciousness, the unconscious, and the pre-conscious brings additional challenges. Such layers can be impacted by applications and technologies, which potentially access information about our mental states. Access to the unconscious, traditionally explored through methods such as dream analysis, can theoretically be affected by neurotechnology.
How can the user protect themselves?
Mori suggests that instead of focusing solely on brain image analysis, we should focus our efforts on protecting mental privacy, which includes the protection of personal opinions, desires, and preferences. The challenge is: how do we ensure that this information remains private, even when we use social networks and mental health apps?
With the intensive use of social networks and information-sharing apps, the space where our private and public lives are situated has become hazy. “When you create a public profile, even if it's professional, you're exposing your image and responding to personal information about yourself,” explains the psychiatrist. “Even this voluntary exposure, while often conscious, raises questions about the control we actually have over the information we share.”
Even so, an Australian study mentioned by Mori reveals a worrying reality: many mental health apps don't offer robust protections for user data.
The research, published in a psychiatry journal in 2019, analyzed 60 apps aimed at mental state assessment, meditation, and other related uses and found significant deficiencies in data protection measures.
In addition, Mori points out the issue of service contracts, which are often accepted without proper reading between the lines. “When we accept the terms of service, we rarely read what's behind the 'accept'. And even when we read, we don't know exactly where our data is going or how it will be shared,” she notes. This common behavior exemplifies the urgent need for greater transparency and control over our personal data”, concludes the expert.
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