More than 1 billion people worldwide live with a mental-health condition, making these disorders the leading cause of disability globally. Depression and anxiety alone cost the global economy an estimated US$1 trillion each year. Two Nature news features examine efforts to address this crisis: one focuses on personalizing psychiatric care, while the other explores the development of psychedelic medicines. Neither approach offers a complete solution, but both point to new ways of improving treatment.
Traditional pharmacological approaches to mental-health care have proved inadequate for many people. To ensure that emerging ideas lead to meaningful improvements, researchers, funders and regulators will need to pursue them rigorously and make successful treatments available as widely as possible.
As psychedelic-development programmes move towards regulatory approval, the U.S. Food and Drug Administration has clarified the evidence and outcomes expected in clinical trials in its guidance on psychedelic drugs and clinical investigations: go.nature.com/4bstrh2.
Providing broad access will be difficult. Many psychedelic drugs and proposed individualized treatments are expensive. They are often developed by small groups for specific symptoms, limiting the benefits of economies of scale. Personalized care could also be inaccessible to people on low incomes, who are more likely than others to experience mental-health conditions.
Why psychiatric care is becoming more personalized
Under the current psychiatric model, two people diagnosed with the same form of depression can have different symptoms, different underlying biology and different responses to the same treatment. This heterogeneity is reflected in clinical outcomes. A substantial proportion of people do not respond to the first antidepressant they try, and about 30% continue to have symptoms after trying several treatments (C. Njenga et al., BMJ 386, e073823; 2024).
Mental-health conditions are more complex than traditional diagnostic categories suggest, partly because those categories rely heavily on subjective reports of symptoms. Precision psychiatry seeks to improve diagnosis and outcomes by cataloguing symptoms in greater detail and as objectively as possible, while also identifying measurable biological indicators, or biomarkers. The hope is that these tools will help clinicians choose more effective treatments sooner.
Potential methods include genetic and blood-based biomarkers, measurements of brain activity using functional magnetic resonance imaging and electroencephalography, and “digital phenotyping”, in which smartphones and other sensors record data such as sleep and movement.
So far, however, these assessments have not produced consistent improvements for people with mental-health conditions. Some researchers propose instead collecting extensive data on how people respond to specific treatments and which responses are associated with improved mental health. Artificial-intelligence models could then use these data to predict how individuals will respond. It remains unclear whether the benefits of such tools will outweigh their costs.
Psychedelics: opportunities and concerns
Psychedelic drugs exploit the brain’s ability to reorganize its connections and circuits. By disrupting rigid patterns, they could produce psychological changes even in some people who have not responded to traditional treatments.
Personalized approaches could help optimize outcomes, but, as with precision psychiatry more broadly, research must examine treatment responses in diverse populations. Psychedelic treatment also raises particular safety concerns. Appropriately trained medical personnel are needed to improve the effectiveness and safety of these drugs, especially during intense, unpredictable and prolonged psychedelic experiences.
Existing treatments, including psychotherapy and antidepressants known as selective serotonin reuptake inhibitors, are highly effective for some people, although their full effects can take time to emerge. Psychedelics’ potential to relieve symptoms rapidly could complement these treatments.
Even highly effective treatment strategies will have limited impact if people cannot access them. Funders and regulators will need to consider who will pay for brain scans, if they prove clinically useful, and for the hours-long sessions needed to administer psychedelics safely. They will also need to determine whether these approaches provide enough benefit to justify the rising costs of mental-health care, and whether those benefits can be delivered equitably.
Some measures could reduce costs and expand access. These include using inexpensive biomarkers and holding supervised sessions in which participants take psychedelic substances together. Some studies have found that group sessions can enhance treatment efficacy in certain circumstances (A. L. Back et al., Journal of Psychedelic Medicine 4, 209–221; 2026). Psychedelics in development that produce shorter-lasting hallucinogenic effects could also offer an alternative.
Prevention remains essential
Advances in diagnosis and treatment must be accompanied by efforts to prevent mental-health conditions from developing. Medical progress cannot replace a society that supports good mental health. More could be done to reduce contributors to mental illness, including financial anxiety, sleep disruption, environmental pollution and social isolation.
The field’s willingness to reconsider how psychiatry works is welcome. Supporters of these approaches must ensure that treatments are available to everyone who could benefit from them, while maintaining the highest quality and strictest safety standards.
Source: www.nature.com