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 emerging approaches—personalized psychiatric care and psychedelic medicine—could improve treatment, but only if researchers, funders and regulators ensure that effective therapies are safe, evidence-based and accessible.
Traditional drug-based approaches have not been sufficient to address the global mental-health crisis. Two Nature news features examine innovations that could change psychiatric care: one focuses on tailoring treatment to individuals, while the other explores the development of psychedelic medicines. Neither is a complete solution, but both bring much-needed new ideas to the field.
For these ideas to improve care in practice, they must be pursued rigorously and with the broadest possible impact in mind. As psychedelic-development programmes move towards regulatory approval, the US Food and Drug Administration has clarified the evidence and results it expects from clinical trials in its guidance on psychedelic drugs and clinical investigations.
Funders and regulators must also ensure that successful approaches reach the people who need them. This will be difficult because many psychedelic drugs and proposed personalized treatments are expensive. They are often developed by small groups for specific symptoms, limiting the economies of scale. Personalized care could therefore be least affordable for low-income people, who are more likely than others to experience mental health conditions.
Moving beyond broad psychiatric categories
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 variation 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 on subjective reports of symptoms. Precision psychiatry aims to improve diagnosis and treatment by documenting symptoms in as much detail and as objectively as possible, while identifying measurable biological indicators known as biomarkers. The hope is that these measures will help clinicians choose more effective treatments sooner.
Potential tools 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 factors such as sleep and movement.
However, these assessments have not yet produced consistent improvements for people with mental health conditions. Some researchers instead propose collecting extensive data on how individuals respond to particular treatments and which responses are associated with improved mental health. Artificial-intelligence models could then use these data to predict how a person might respond. It remains unclear whether the benefits of such tools will outweigh their costs.
Psychedelics: concerns and opportunities
Psychedelic drugs exploit the brain’s ability to reconfigure its connections and circuits. By disrupting rigid patterns, they could produce psychological changes even in some people who have not benefited from traditional treatments.
Personalized approaches could potentially improve outcomes, but, as with precision psychiatry more broadly, research must examine treatment responses across diverse populations. Psychedelic treatment also presents additional safety concerns. Appropriately trained medical personnel are needed to improve its effectiveness and safety, particularly 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 provide rapid relief from symptoms could complement these treatments.
Even highly effective treatment strategies will have limited value 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 required to administer psychedelics safely. Researchers and policymakers 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.
One way to reduce costs and expand access could be to use inexpensive biomarkers and supervised group 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 being developed to produce shorter-lived hallucinogenic effects could also offer an alternative.
Prevention and equitable access
Progress in diagnosis and treatment must be paired with efforts to prevent mental health disorders from developing. Medical advances cannot replace a society that supports good mental health. More can be done to address factors that contribute to mental illness, including financial anxiety, sleep disturbances, environmental pollution and social isolation.
The willingness to rethink psychiatry is welcome. But supporters of these approaches must ensure that treatments are available to everyone who could benefit from them, while maintaining the highest standards of evidence, quality and safety.
Source: www.nature.com
