Writer: Maria Kuratana
Editor: Ayotenu Dosumu
Artist: Meera Maniar
Introduction
According to the British Medical Association, the proportion of adults aged 16-74 receiving mental health treatment has risen from 23.1% in 2000 to 39.4% in 2014. In response to this upward trend, new technologies have emerged – particularly in the field of bioengineering. Bioengineering is “the application of engineering, life sciences and mathematical principles to address problems in fields involving living systems – biology, medicine, health care and more”. With the demand for mental health treatment increasing, bioengineering may be one of the ways to tackle this problem?
Current mental health treatment
There are a range of treatments currently in clinics, from medications like antidepressants, to cognitive behavioural therapy (CBT). However, how effective are they really? Trials have demonstrated that pharmacotherapy for social anxiety disorder and generalised anxiety disorder have given response rates of 52% and 56%, respectively, compared to 32% and 41% with a placebo. This implies that although there is a response rate increase compared to one another, it is not significant. Furthermore, a 2020 NHS survey revealed that only 44% of respondents found their medication helpful. This indicates new measures are needed to help fill in the gaps in current mental health treatment.
Precision psychiatry: Diagnosing psychiatric disorders
Classification of mental health disorders in a clinical setting is a crucial step that allows patients to start their correct treatment. The Diagnostic and Statistical Manual Mental Disorders 5 (DSM-5) and the International Classification of Diseases 10 (ICD-10) have been found to be some of the most useful diagnostic tools for psychiatric disorders. However, where they lack in specificity and precision, personalised psychiatry could make up for through Precision psychiatry.
Precision psychiatry is the tailoring of medicine and treatment to a specific person’s needs by looking at inputs such as clinical symptoms, individual and environmental risk factors, biomarkers, and more. Through analysis with artificial intelligence and machine learning, diagnosis, disease susceptibility, treatment selection and dosage, and prognosis could all be improved.
Bioengineering would be used to collect more quantifiable data through molecular, genetic and structural markers. By measuring the levels or specific molecular markers associated with specific diseases within patients, accurate diagnoses can be made. For example, interleukin-6 levels are elevated in patients with schizophrenia and bipolar disorders, compared to healthy controls. This is similar to genetic markers as studies demonstrate that people with DiGeorge syndrome, which is a microdeletion on chromosome 22p11.2, have a higher risk of developing schizophrenia. Furthermore, the use of functional Magnetic Resonance Imaging (fMRI) to understand brain areas and their association with psychiatric disorders would additionally benefit the diagnostic process. MRIs have demonstrated that enlargement of the lateral ventricles, and reduction in hippocampus size are associated with depression and schizophrenia, and are linked to impaired brain function, such as cognitive impairment or reduced functional efficiency.
In short, the efficacy and applicability of these technologies have to be evaluated before being implemented into clinical practice but have a high potential in helping with a more precise diagnosis of mental health disorders.
Treating mental health with bioengineering
Technologies such as repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS) are increasingly popular approaches for mood-based mental health disorders. Neuromodulation technique rTMS aims to treat major depression (MDD) and treatment resistant depression (TRD) by stimulating focal cortical brain regions with electrical currents by using a magnetic field. DBS, on the other hand, reportedly overrides limbic-cortical connection hyperactivity responsible for MDD. These therapies would allow mood regulation, overall benefiting patient experience. However, proceeding with these therapies requires careful consideration. DBS has side effects such as seizure, stroke, and headache and does not necessarily cure one’s condition; rTMS similarly may cause scalp discomfort, pain and headache but requires repetitive treatment.
Closed-loop neuromodulation devices are an additional therapy that is being explored for the treatment of epilepsy. A patient’s neural state is monitored and treated through delivering and adjusting therapeutic electrical stimulation. This technology could potentially allow an instantaneous self-regulation of the emotional needs of a person but could result in hardware complications.
Most of these technologies are still undergoing trials, demonstrating that they are more for future rather than present application.
Concerns regarding bioengineering shaping mental health
When bringing about new technology, the ethical considerations of both its research and implementation within clinics are incredibly important.
Aspects to take into account include:
- Purpose: Why is the technology being used and how necessary is it?
- Normality: What will the parameters of ‘normality’ be? Who sets this?
- Consequences: What are the long-term impacts? Safety?
All these together will start the basis of ethical points to be addressed but further discussion and agreement will need to be taken into consideration to develop these further.
Yay or nay?
Considering current treatments and bioengineering development, is bioengineering for mental health a yay or nay? There are so many areas that bioengineering can be applied in regarding mental health, both for diagnosis and treatment. It would potentially allow a better treatment path for patients and improve the current clinical market. Although there are large benefits, if concerns regarding the implementation of technology can not be addressed clearly and fairly, the usage of bioengineering for mental health should not yet be implemented. In addition, treatment should be tailored towards each patient after considering the risks and benefits.
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