Severe mood disorders are common and sometimes among the most disabling of all medical illnesses, says psychiatrist Fernando Goes, M.D., director of the Precision Medicine Center of Excellence in Mood Disorders. The good news, he says, is that many forms of effective treatments are available, ranging from antidepressant medications to evidence-based psychotherapies.

But for reasons that are still unclear, as many as one-third of people with ailments like major depressive disorder and bipolar disorder do not achieve significant improvement from first-line treatments. Instead, they may require newer types of medications or brain stimulation approaches.

Goes, along with center co-director and psychiatric epidemiologist Peter Zandi, Ph.D., M.H.S., M.P.H., and colleagues at the center and Department of Psychiatry and Behavioral Sciences, aim to uncover some of the reasons why individuals have difficult-to-treat mood disorders and provide new, improved treatments to those who are suffering. 

Precision Medicine at Work

Johns Hopkins investigators are probing genetic clues, lab results and digital phenotyping — a process of studying data collected by devices like smartwatches that track markers of depression and anxiety — to assess patients, with the idea to provide psychiatric counseling and help match them to the most effective treatment, ideally avoiding the trial and error that many individuals suffering with these disorders experience.

The work-up begins with giving all patients a basic questionnaire, taking only a few minutes. A subset of patients also will be encouraged to provide mobile mood measurements, basic actigraphy (body movement) and sleep measurements. Once completed, the results are collected at regular clinic visits and made available to health care providers as part of the patient’s clinical record.

Researchers and clinicians at the center can then tap into expertise across medical specialties at Johns Hopkins Medicine to provide additional treatments, such as rapid-acting antidepressants, new forms of transmagnetic stimulation (TMS; a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain), and more selective use of available treatments to those who are more likely to respond to them.

“Our goal is to find clues to the root of the condition that will ultimately lead to new, urgently needed, targeted drugs,” Goes says. The team also envisions the creation of a biobank with human tissue and blood specimens available to all researchers in the Johns Hopkins community.