Looking Ahead

As you look to the future, what breakthroughs in psychiatric medicine do you believe will occur during the next 100 years?

Clinical screening for depression, bipolar and other psychiatric disorders will occur at earlier stages in life to aid in diagnosing earlier, when the symptoms are milder and easier to treat. Genetic screening will be routine. Complex genetic profiles will be inexpensive, confidential, and safely identify those with greatest vulnerability at a time when depression and other disorders are most treatable. Genetic testing will be linked with other measures such as brain imaging to help characterize underlying disorders for each person, a personalized medicine approach that is similar to what is done for heart disease.

New treatments will be available to help prevent actual onset of symptoms in those with greatest genetic vulnerabilities. Other genetic testing may identify unique genetic resiliencies that enable individuals to respond favorably to severe stresses and new treatments might be developed to help us turn on those genes that keep us healthy, to supplement or replace treatments that turn off those genes associated with depression and bipolar disorders, for example.

Pharmacogenetics will be routine to enable clinicians to select those medications that are safely metabolized and tailored to each person’s unique genetics. Interventions will regularly incorporate scientific advances in nutrition, exercise and chronobiology — the biology of our rhythms. Stigma associated with depression will be almost nonexistent. I am confident we will see most of these changes, and I can’t wait.