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Precision Psychiatry: The Biggest Revolution in the History of Psychiatry2026-02-09

Psychiatry deals with a most important subject matter, the mind and its (mal)functioning. Everything else nowadays is downstream of the mind. Yet psychiatry as still practiced is a relic in medicine. Imprecise diagnosis. Trial and error treatments, albeit with powerful medications, which can backfire. No continuous at home monitoring.

To prescription for improvement is simple, albeit not easy. Diagnosis has to be based on measurements and on a nosology that maps closer to reality. Treatments should be matched to the biological profile of the individual, in a personalized way. Monitoring of response to treatment, for adjustments and prevention, should be routine. In other words, psychiatry can be more like diabetes and cancer care.

The tools to do all that are here. The newer blood gene expression (RNA) biomarker tests for assessment and matching to medications1-7, and the older genetic (DNA) tests for medication dosage, are available to clinicians and patients. They have been developed over the last two decades, and have been used by early adopters over the last 5-10 years. Not many people know about them, or use them yet, particularly the blood testing. With education and wider dissemination, that will change.

A problem of the older genetic testing was the exaggerated nature of marketing claims, about helping choose treatments. They do no such thing. They only help chose dosage for a particular medication you want to use, by providing you information if the patient is a fast or slow metabolizer8.

The blood biomarker testing is broader spectrum, should be used first line, as it provides objective information on disease severity, future risk, as well as genuine matching to medications, often older well established, safe, and inexpensive ones (such as low dose lithium). By combining multiple blood tests in a single liquid biopsy, a molecular differential diagnosis and integrative treatment suggestions can be generated. Such tests do not diagnose or treat people, clinicians do. But they provide information so the clinician can fly using instruments, not by looking out the window.

I encourage patients, families, clinicians, pharma companies, and payors to give these new developments a try, to see through direct experience how useful they are. If you care about outcomes, then what do you have to lose? The status quo isn’t working well at all. In most cases we participated in (https://mindxsciences.com/ ), that were thought to be complex and treatment-resistant, the diagnostic, co-morbidity, and especially treatment suggestions, were transformative, leading to deprescribing, fewer and better meds (and nutraceutical) matches, and better outcomes. Let’s not forget lifestyle changes, and positive psychology injected into daily life, all empowered by digital tools, and you have a complete solution for a revolution in mental health, and in society at large.

Live. Happier. Longer.

Alexander B. Niculescu, MD, PhD Founder +CEO| MindX Sciences https://mindxsciences.com/

References:

1. Le-Niculescu H, Roseberry K, Levey DF, Rogers J, Kosary K, Prabha S et al. Towards precision medicine for stress disorders: diagnostic biomarkers and targeted drugs. Mol Psychiatry 2019.

2. Le-Niculescu H, Roseberry K, Gill SS, Levey DF, Phalen PL, Mullen J et al. Precision medicine for mood disorders: objective assessment, risk prediction, pharmacogenomics, and repurposed drugs. Mol Psychiatry 2021; 26(7): 2776-2804.

3. Niculescu AB, Le-Niculescu H. Precision medicine in psychiatry: biomarkers to the forefront. Neuropsychopharmacology 2022; 47(1): 422-423.

4. Roseberry K, Le-Niculescu H, Levey DF, Bhagar R, Soe K, Rogers J et al. Towards precision medicine for anxiety disorders: objective assessment, risk prediction, pharmacogenomics, and repurposed drugs. Mol Psychiatry 2023.

5. Bhagar R, Gill SS, Le-Niculescu H, Yin C, Roseberry K, Mullen J et al. Next-generation precision medicine for suicidality prevention. Transl Psychiatry 2024; 14(1): 362.

6. Hill MD, Gill SS, Le-Niculescu H, MacKie O, Bhagar R, Roseberry K et al. Precision medicine for psychotic disorders: objective assessment, risk prediction, and pharmacogenomics. Mol Psychiatry 2024.

7. Bhagar R, Le-Niculescu H, Corey SC, Gettelfinger AS, Schmitz M, Ebushi A et al. Next-generation precision medicine for pain. Mol Psychiatry 2025.

8. Parikh SV, Law RA, Hain DT, Rothschild AJ, Thase ME, Dunlop BW et al. Combinatorial pharmacogenomic algorithm is predictive of sertraline metabolism in patients with major depressive disorder. Psychiatry Res 2022; 308: 114354.