Precision psychiatry is the future of mental healthcare

For over a hundred years, psychiatry has existed at the intersection of science and art. Unlike other fields of medicine, which rely on blood tests, cultures, imaging, or tissue samples for diagnosis, mental healthcare has historically depended on symptoms alone: clusters of behavior and emotion interpreted through self-report and clinical observation. Diagnoses are made without directly examining the brain, and treatment has long been a process of trial-and-error, prescribing medications or therapy without knowing exactly what will help or why and further plagued by drugs with serious side effects and inconsistent efficacy. 

This is not due to a lack of rigor or compassion among psychiatrists, but because, until recently, we lacked the tools to study the brain in ways that could inform diagnosis and treatment at the individual level. That is now changing. Breakthroughs in neuroscience, neuroimaging, and molecular biology are quietly transforming psychiatry, offering the potential to fundamentally reshape how we understand, diagnose, and treat mental illness. 

This shift marks the rise of precision neuroscience – an emerging model of mental healthcare that uses biomarkers, brain circuits, and individualized data to guide treatment, much like precision oncology has done for cancer.

A chemical revolution with biological blind spots

In the mid-20th century, psychiatry moved from early psychoanalytic theories to biological psychiatry with the advent of psychotropic drugs like chlorpromazine and lithium. These medications were often discovered by accident and prescribed based on observable symptoms, not underlying biology. And while their discoveries represented a significant advancement, they also revealed key limitations: unpredictable effectiveness, serious side effects due to indiscriminate binding throughout the brain, and a lack of understanding about how they actually worked. 

The issues with the drugs themselves have been compounded by shortcomings in diagnosis. Patients with the same diagnosis could respond in drastically different ways, exposing a fundamental problem: diagnostic categories that lump together biologically distinct conditions. We would never treat all forms of chest pain with the same drug. Why should we do that for depression, anxiety, or PTSD? 

Stuck with diagnostic methods that focus on symptoms instead of biology, another problem emerges: subjectivity. Diagnosis becomes dependent on the skill of the clinician instead of measurable tests, injecting inconsistency into mental healthcare and risking misdiagnoses and inaccurate treatment routing. 

A neural blueprint of psychiatric illness

Only in recent decades have we begun to understand the brain’s complexity, including how specific mental health conditions arise from disruptions in discrete brain circuits and in discrete regions of the brain. Depression, for instance, increasingly appears to involve altered connectivity in networks responsible for mood, motivation, and reward. PTSD is associated with dysregulation in circuits involving the brain’s fear center, the amygdala, as well as the hippocampus and prefrontal cortex. These are not just theories; they reflect measurable, biological patterns in the brain. In my own research, we identified a biomarker for PTSD: elevated levels of a specific protein in the amygdala linked to trauma-related fear learning. Such biological signatures not only unlock objective diagnoses but also pinpoint clear targets for treatment.

The future of psychiatry will be predicated on improving diagnostic accuracy, designing precision treatments, and using those diagnostic tools to match patients with therapies tailored to their unique biological profiles.

Translating precision psychiatry into clinical reality

This is the essence of precision neuroscience. Just as oncologists now routinely use genetic testing to tailor cancer treatment, psychiatry can use biological data to route patients to the most effective interventions. Imagine diagnosing PTSD with a brain scan, or predicting whether a patient will respond best to SSRIs, exposure therapy, or neuromodulation – not based on trial-and-error, but on measurable biology. 

To make this vision a true reality, we need more than promising science. We need large-scale studies pinpointing the underlying biology of diseases and connecting brain biomarkers to symptoms and outcomes. Our diagnostic systems must then evolve beyond behavior alone to incorporate those biological insights, while treatments must be designed to target the root biological dysfunction.

Companies are indeed developing drugs designed to target specific brain circuits and singular neuroanatomical regions affected by dysfunction rather than the conventional broad-acting medications. Relatedly, medtech solutions like transcranial magnetic stimulation and focused ultrasound can modulate activity in precisely defined areas. Combined with biomarkers, these tools have the ability to personalize care so patients can be diagnosed properly and receive the right treatment, at the right time, with fewer side effects and better outcomes. 

Beyond R&D, regulatory agencies like the FDA must develop frameworks for approving and adopting biomarker-based diagnostics and targeted treatments, while clinicians will need education and training to use these tools effectively. And insurance providers and payors must adapt to support precision approaches, not just conventional ones. 

Precision psychiatry is a better path forward

Mental illness is a biological illness. Yet for too long, psychiatry has been treated as something separate from the rest of medicine, marked more by uncertainty than precision, and more by stigma than understanding. Precision psychiatry offers a better path forward. It will not replace therapy or the human connection so vital to healing, but it will allow us to ground our care in biology and match patients with treatments that truly work. We owe it to our patients – and to ourselves – to bring psychiatry into the era of precision medicine.