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t m c » p u l s e | j u ly 2 0 1 6 34 Personalizing Psychiatry Data-driven health care aims to intercept major depressive disorder diagnoses with more targeted treatments P roviding patients with the best health care is a goal for many physicians, and one of the ways they are trying to achieve that goal is through personalized medicine. This area of medicine is gaining traction, particularly in oncology, with the examination of genomes and phenotypes, but some Texas Medical Center researchers and doctors think that same method can also be tailored to patients in other areas, like psychiatry. Using genes and phenotypes, the ultimate goal is to develop therapies that can intervene in earlier stages of illness, enabling physicians to provide modified disease courses and improve prognoses. Treatments like these may be developing just in time: The World Health Organization estimates that by 2030, major depressive disorders will rank first in global disease burden, as measured in Disability Adjusted Life University of Texas Health Science Center at Houston (UTHealth). Because it is not yet known how individual genes can be used to alter brain function, her research involves understanding how cellular pathways are disrupted by mutations within these genes, in combination with environmental stressors. As part of this, Walss-Bass' work involves looking at high-risk populations: Children who are the offspring of parents with Years, mainly because depression can affect anyone and often co-exists with other illnesses. Focus on the pathway Thought to be genetic, conditions like bipolar disorder also need a certain environment in order to manifest, said Consuelo Walss-Bass, Ph.D., associate professor of psychiatry and director of the Psychiatric Genetics Program at McGovern Medical School at The bipolar disorder or depression. "It's not just that you inherit a set of genes, but the environment plays an important role in modulating genes," she said. "Living with a parent with those disorders is stressful." Studying children at risk, but who have not yet developed the disorder, is an important angle for Walss-Bass' research team, headed by Jair Soares, M.D., Ph.D., professor and Pat R. Rutherford Jr. Chair in the Department of Psychiatry and Behavioral Sciences and executive director of the UTHealth Harris County Psychiatric Center. Full onset of schizophrenia, depres- sion and bipolar disorder often occurs in late teens or early 20s, which is why most studies of these disorders are on adults, Walss-Bass said. In addition, most studies of individuals with these disorders take place after the person has been ill for some time. Therefore, when looking at brain alterations— imaging, cognition—it's difficult to know whether any disturbances are from the burden of the disease, or the effectiveness of the medication, or are, in fact, alterations that led to develop- ment of the disorder. "That is why we are studying high- risk children who have not yet become ill, because we know they have inher- ited some of the genes. It is not one, two or three, it may be as many as 20 or 30," she added. "We want to study the subtle alterations caused by mutations within these genes because it is the combination of them that leads to the Left to right: Guy Seabrook, Ph.D., Consuelo Walss-Bass, Ph.D., Lynda Chin, M.D. B y C h r i s t i n e H a l l