This will be the “year of clinical validation” for emerging digital technology for the treatment of mental health, according to Arshya Vahabzadeh, MD, from the Massachusetts General Psychiatry Academy in Boston.
“Digital therapeutics are a very hot area in mental health, and one that will only continue to grow,” said Vahabzadeh, who is participating in several panels in which participants discuss new brain-related technologies and tools at the Consumer Technology Association 2019 Digital Health Summit in Las Vegas.
Mental health treatment has always been a subjective clinical “snapshot” of behavior and emotion assessed during an interview with a patient. However, with new technologies, that is going to change, Vahabzadeh told Medscape Medical News. The spectrum of options to treat pain, addiction, and psychiatric conditions will be transformed.
“Through a range of connected devices, we can now monitor attributes in a more quantitative and continuous manner,” he explained. New technologies offer the ability to detect human behavior and measure things like mood, sleep, and movement, giving clinicians “the amazing opportunity to use quantitative metrics that will augment our decision making.”
The hard part will be to take the masses of quantitative data generated and make sense of it in a manner that can drive clinical decision making.
That opens up tremendous potential, he said, but as the validation aspect of the equation grows, it is important not to get swept away by it. “The hard part will be to take the masses of quantitative data generated and make sense of it in a manner that can drive clinical decision making.
“This space is ripe for technological interventions,” he explained, pointing to several companies that are forerunners in the mental health space and are presenting products at the summit that are already approved by the US Food and Drug Administration (FDA).
A front-runner in the digital therapeutic space, Pear Therapeutics, received FDA approval a few months ago for reSET-O, which was presented at last year’s summit. The software is used in conjunction with buprenorphine (multiple brands) and counseling. Clinical evidence has shown that it can decrease illicit drug use and improve abstinence in patients with opioid use disorder.
A new device that uses ingestible event marker sensors to monitor adherence to aripiprazole (multiple brands) has also been approved by the FDA. The sensors can detect and report through a smartphone app whether patients with psychiatric conditions such as schizophrenia, bipolar disorder, or major depressive disorder have taken their medication.
Technologies that offer visual aids and cues are also emerging in the mental health space.
DTHR-ALZ, an FDA-approved digital therapeutic, can deliver reminiscence therapy to people with Alzheimer’s disease. The tool can present patients with images of their loved ones to mitigate symptoms of agitation and depression, said David Keene, cofounder of Dthera Sciences.
The software uses a camera on a mobile device, such as a tablet, to detect reactions to memory aids. It assesses patient biofeedback and then applies an algorithm to present images that reduce and prevent agitation, he explained.
In addition to new technologies, more sophisticated applications for known therapies are also being developed.
Google Glass technology helps adults and children with autism master social communication, Vahabzadeh, who is chief medical officer at Brain Power LLC, reported. The augmented-reality smartglasses — which incorporate a camera, microphone, touchpad, blink sensor, gyroscope, and an accelerometer — help direct the wearer’s attention and improve communication. These glasses can reduce symptoms of attention-deficit/hyperactivity disorder, according to a recent study reported by Medscape Medical News.
New advances in neurostimulation for spinal cord stimulation were discussed in a session moderated by Steven Falowski, MD, from St. Luke’s University in Bethlehem, Pennsylvania. The panel talked about how the nervous system responds to electrical stimulation to treat dystonia, epilepsy, essential tremor, and Parkinson’s disease and to reduce pain and potentially eliminate the need for opioid use after surgery.
Spinal Cord Stimulation
This strategy has been validated by recent studies showing that neuromodulation is associated with greater pain reduction than pharmacotherapy in patients with intractable spine or limb pain, as reported by Medscape Medical News.
The benefits of spinal cord stimulation have been understood for some time, but advances in this technology “have quadrupled in the past 5 years,” Falowski told Medscape Medical News. “An explosion in the available technology — now smaller and more reliable — has made us better at implanting. It takes less than an hour,” he said. Falowski said he sees the potential for using the technology temporarily — for 30 to 60 days — after orthopedic surgery or when a patient is in pain.
“The idea is that we could use spinal cord stimulators and never put anyone on opioids, or wean those already on opioids,” he said.
Although technologies are being validated and backed by clinical trials, it is prudent to proceed with caution and take privacy into consideration, Vahabzadeh told Medscape Medical News.
The new gadgets can generate a lot of excitement, but “we must not let that cloud our ability to understand the risks and the benefits of these devices when we consider mental health conditions,” he cautioned.
Vahabzadeh is director of digital health at Brain Power, LLC. Falowski reports financial relationships with Abbott, Medtronic, Nevro, Saluda, Vertiflex, St. Jude, Nuvectra, and Springer and has ownership stakes in Neural Integrative Solutions, Suture Concepts, Spine Thera, and SPR therapeutics.