How to have a psychiatrist in your pocket
Vitamin Z is a newsletter about health and wellness. If you are new, you can join here:
Apple is working on iPhone features to help detect depression and cognitive decline, the Wall Street Journal reported in September. The company is working with UCLA and Biogen to see if data like facial expressions and typing metrics could signal mental health issues.
Reactions on Twitter ranged from cynical…
…to cautiously optimistic:
Apple’s approach is referred to as digital phenotyping—using data collected from smart devices to build a rich, personalized digital picture of behavior, track markers of depression and anxiety, and develop new ways to diagnose illness.
There are obvious privacy concerns. Not everyone will love the idea of their iPhone tracking their emotions. (Then again, the iPhone can already infer 10 moods about you based on what you type. They include “anxiety,” “anger,” “positive,” and “death.”)
People are understandably wary of big tech companies getting inside their heads. Yet technology may be the only way to scale mental health services to the millions in need.
Covid led to an increase in people suffering from anxiety and depression. Children were among the hardest hit. The number of children ages 6-12 who visited children’s hospitals for suicidal thoughts or self-harm has more than doubled since 2016.
Psychiatry has relied almost exclusively on self-reports of mental health symptoms. There are few biological markers. Diagnostic categories are often unclear. As a result, people are not properly diagnosed and don’t get the mental health treatment they need.
How can digital tools help?
The rise of mental health tech
Investors this year have poured over $3 billion into startups focused on digital solutions for mental and behavioral health. The space includes digital therapeutics (Calm, Headspace), telepsychiatry (TalkSpace, Lyra) and hardware devices (Muse, Sana).
Spring Health raised $190 million in September for its mental health benefits platform for employers. The solution collects data on employees and matches them with mindfulness and meditation, care navigation, coaching, therapy and medication management.
Doctors and tech leaders are exploring how so-called digital biomarkers could help monitor patients with mental health conditions. Beth Israel’s Division of Digital Psychiatry created a tool that collects both active data, like surveys and cognitive tests, and passive data, including GPS accelerometer logs and call logs from a patient’s smartphone.
The promise of detection tools for people with severe neurological or mood disorders is that you could warn people they might be at risk and prompt them to seek care. These conditions typically require diagnosis by a specialist, which is not available or accessible to many people. Traditional diagnosis often relies on self-reported questionnaires or caregiver observations, which are subjective and not always reliable.
I spoke to a psychiatrist about the challenges of mental health diagnosis. He said:
“Treatment in community practices is not always measurement-based. It’s not subject to the same clinical rigor as other medical specialties. It’s ripe for innovation. With technology, we can design closed-loop systems where patients can be tracked over time.”
A real-time scorecard for mental health
I spoke with Roy Cohen, co-founder and CEO of a startup called Behavidence. The company has developed a behavior-monitoring smartphone app that can track usage patterns and automatically detect and recognize shifts in depression and anxiety.
Roy said:
“Psychiatry is the least accurate field of medicine. Disorders are grouped together with no biological models behind them. Diagnosis is mostly defined by questionnaires and interviews, making them biased.”
Studies have shown that psychiatric diagnoses of mental health disorders like depression have limited accuracy:
Behavidence has developed digital phenotypes for depression, anxiety and ADHD, and is developing phenotypes for schizophrenia, bipolar disorder, autism, PTSD, opioid addiction, and employee burnout.
The use of digital biomarkers has several advantages: You can monitor your mental health continuously, accurately, and privately. It’s easy to validate your mental health scores and share them with your therapist. You can track your scores over time and see what life events correlate with better or worse mental health.
Roy said the company’s digital phenotypes were validated during the recent Israel-Palestine conflict:
“The app showed that every time a missile was heading to Tel Aviv, people’s anxiety levels went up. We realized, it’s working!”
The app was able to detect the mental health impact of Covid in India:
“We've seen depression and anxiety levels rise significantly within our users in India following the second outbreak of Covid-19 that took thousands of lives.”
Behavidence has signed contracts with employers and insurance companies to help them reveal underlying mental health conditions, monitor them over time and help people find a better route to recovery.
Early detection of Alzheimer’s
Other startups are using tech to improve diagnosis of neurodegenerative diseases like Alzheimer’s and Parkinson’s. Today, nearly 55 million people suffer from Alzheimer’s disease or related dementias. According to the WHO, dementia is the fastest-growing burden on healthcare systems and the seventh-leading cause of death worldwide.
Neurological diseases like Parkinson’s and Alzheimer’s are slow killers. They are very difficult to measure and treat. Patients and their loved ones are typically at the mercy of the disease.
Bill Gates has written about his foundation’s support for projects focused on developing reliable, affordable biomarker tests for Alzheimer’s. Traditional approaches to diagnosis (brain amyloid PET scans and traditional cognitive tests) are giving way to new diagnostics, such as blood and ocular biomarker tests and cell phone apps.
A company called Altoida has developed a non-invasive software device to monitor cognitive function and predict whether mild cognitive impairment will escalate to Alzheimer’s Disease.
Altoida collects personalized brain data by asking users to complete a 10-minute set of augmented reality and motor activities on their smartphone or tablet. With this data, the device uses AI to predict whether a person aged 55 or older with mild cognitive impairment will develop Alzheimer’s Disease.
The company recently announced the launch of a comprehensive Alzheimer’s disease study in partnership with Eisai US and Ionian University’s BiHELab.
Diagnosing the condition sooner, before symptoms have begun to appear, could help physicians begin to treat at-risk patients, potentially delaying the onset or lessening the severity of the neurodegenerative disease.
Look into my eyes
Could your eyes be a window into brain health?
A company called NeuraLight raised $5.5 million last month to apply AI to advance drug development for neurological disorders. The team has built a platform that automatically extracts microscopic eye movement measurements that correlate with neurological disorders. The platform does not require a dedicated camera eye-tracker and can be used with video from a standard smartphone or webcam.
The NeuraLight platform is being studied in the US and Israel. It could accelerate clinical trials for new therapies for Parkinson’s, Alzheimer’s, multiple sclerosis and other neurodegenerative diseases.
The evidence base for these products is still building. More studies will be needed to validate which ones are most effective in helping people monitor mental health. Winning solutions will need to comply with privacy and security requirements, show diagnostic accuracy, and pass regulatory scrutiny.
The hope is that we’ll soon have more accurate, non-invasive methods for diagnosing mood disorders and degenerative brain diseases earlier in their development.
Until next week,
By Daniel Zahler
Hi there! Thanks for reading. If you stumble on my newsletter, you will notice that I write about health and wellness trends, and strategies & tactics on how to optimize cognitive, physical and emotional health. I hold a JD and BA from Harvard, have worked at Goldman Sachs and McKinsey, and serve as a GLG council member advising global business leaders on healthcare innovation.
Check out my articles in Thrive Global here.
Enjoy this?
There are a few things to do:
Follow me on Twitter.
Hit reply with your feedback and ideas :)
Share this post with others.