A software company Shrink Apps and Wearable Can Usher In The Age Of Digital Psychiatry

Zach has been having trouble at work, and when he comes home he’s exhausted, yet he struggles to sleep. Everything seems difficult, even walking—he feels like he’s made of lead. He knows something is wrong and probably should call the doctor, but that just seems like too much trouble. Maybe next week.

Meanwhile, software on his phone has detected changes in Zach, including subtle differences in the language he uses, decreased activity levels, worsening sleep, and cutbacks in social activities. Unlike Zach, the software acts quickly, pushing him to answer a customized set of questions. Since he doesn’t have to get out of bed to do so, he doesn’t mind.

Zach’s symptoms and responses suggest that he may be clinically depressed. The app offers to set up a video call with a psychiatrist, who confirms the diagnosis. Based on her expertise, Zach’s answers to the survey questions, and sensor data that suggests an unusual type of depression, the psychiatrist devises a treatment plan that includes medication, video therapy sessions, exercise, and regular check-ins with her. The app continues to monitor Zach’s behavior and helps keep his treatment on track by guiding him through exercise routines, noting whether or not he’s taking his medication, and reminding him about upcoming appointments.

While Zach isn’t a real person, everything mentioned in this scenario is feasible today and will likely become increasingly routine around the world in only a few years’ time. My prediction may come as a surprise to many in the health-care profession, for over the years there have been claims that mental health patients wouldn’t want to use technology to treat their conditions, unlike, say, those with asthma or heart disease. Some have also insisted that to be effective, all assessment and treatment must be done face to face, and that technology might frighten patients or worsen their paranoia.

However, recent research results from a number of prestigious institutions, including Harvard, the National Alliance on Mental Illness, King’s College London, and the Black Dog Institute, in Australia, refute these claims. Studies show that psychiatric patients, even those with severe illnesses like schizophrenia, can successfully manage their conditions with smartphones, computers, and wearable sensors. And these tools are just the beginning. Within a few years, a new generation of technologies promises to revolutionize the practice of psychiatry.

To understand the potential of digital psychiatry, consider how someone with depression is usually treated today.

Depression can begin so subtly that up to two-thirds of those who have it don’t even realize they’re depressed. And even if they realize something’s wrong, those who are physically disabled, elderly, living in rural areas, or suffering from additional mental illnesses like anxiety disorders may find it difficult to get to a doctor’s office.

Once a patient does see a psychiatrist or therapist, much of the initial visit will be spent reviewing the patient’s symptoms, such as sleep patterns, energy levels, appetite, and ability to focus. That too can be difficult; depression, like many other psychiatric illnesses, affects a person’s ability to think and remember.

The patient will likely leave with some handouts about exercise and a prescription for medication. There’s a fair chance that the medication won’t be effective at least for many weeks, the exercise plan will be ignored, and the patient will have a bumpy course of progress. Unfortunately, the psychiatrist won’t know until a follow-up appointment sometime later.

Technology can improve this outcome, by bringing objective information into the psychiatrist’s office and allowing real-time monitoring and intervention outside the office. Instead of relying on just the patient’s recollection of his symptoms, the doctor can look at behavioral data from the person’s smartphone and wearable sensors. The psychiatrist may even recommend that the patient start using such tools before the first visit.

It’s astonishing how much useful information a doctor can glean from data that may seem to have little to do with a person’s mental condition. GPS data from a smartphone, for example, can reveal the person’s movements, which in turn reflects the person’s mental health. By correlating patients’ smartphone-derived GPS measurements with their symptoms of depression, a 2016 study by the Center for Behavioral Intervention Technologies at Northwestern University, in Chicago, found that when people are depressed they tend to stay at home more than when they’re feeling well. Similarly, someone entering a manic episode of bipolar disorder may be more active and on the move. The Monitoring, Treatment, and Prediction of Bipolar Disorder Episodes (Monarca) consortium, a partnership of European universities, has conducted numerous studies demonstrating that this kind of data can be used to predict the course of bipolar disorder.

Where GPS is unavailable, Bluetooth and Wi-Fi can fill in. Research by Dror Ben-Zeev, of the University of Washington, in Seattle, demonstrated that Bluetooth radios on smartphones can be used to monitor the locations of people with schizophrenia within a hospital. Data collected through Wi-Fi networks could likewise reveal whether a patient who’s addicted to alcohol is avoiding bars and attending support-group meetings.

Accelerometer data from a smartphone or fitness tracker can provide more fine-grained details about a person’s movements, detect tremors that may be drug side effects, and capture exercise patterns. A test of an app called CrossCheck recently demonstrated how this kind of data, in combination with other information collected by a phone, can contribute to symptom prediction in schizophrenia by providing clues on sleep and activity patterns. A report in the American Journal of Psychiatry by Ipsit Vahia and Daniel Sewell describes how they were able to treat a patient with an especially challenging case of depression using accelerometer data. The patient had reported that he was physically active and spending little time in bed, but data from his fitness tracker showed that his recollection was faulty; the doctors thus correctly diagnosed his condition as depression rather than, say, a sleep disorder.

Tracking the frequency of phone calls and text messages can suggest how social a person is and indicate any mental change. When one of Monarca’s research groups [PDF] looked at logs of incoming and outgoing text messages and phone calls, they concluded that changes in these logs could be useful for tracking depression as well as mania in bipolar disorder.