CU Anschutz faculty drive innovation to tackle national mental health crisis

Psychiatry faculty at the University of Colorado Anschutz Medical Campus embrace their vulnerabilities and tell personal stories about how they innovate across disciplines and use digital technology, new drugs, and deep brain stimulation. We shared how we are transforming the landscape of mental health treatment.

They presented their new findings in mental health to an audience of over 100 at the Transforming Healthcare Community lecture at CU Anschutz on November 1st.

Before COVID-19 emerged, the country was already dealing with a growing mental health crisis. This problem has been exacerbated by the pandemic, and the lack of health care providers and adequate treatment has become a serious problem. In his opening remarks, CU Anschutz President Don Elliman reminded the audience of a decision he made four years ago to transform the role of campuses in mental health in Colorado.

“Before that, my main focus was on research and teaching,” he said. “The number of lives we touched increased by 400% each year.”

The role of digital technology in therapy

Neill Epperson, MD, professor of psychiatry at the CU School of Medicine, said he was once hesitant to use digital technology to treat mental illness. Her main concerns centered on the lack of evidence of efficacy or safety and the loss of critical patient-provider relationships.

Pictured from left: Yuzuru Sakai, MD, a psychiatric faculty member. Neil Epperson, MD. Jay Shore, MD, MPH. Andrew Novick, M.D., Ph.D. and Rachel Davis, MD.

But knowing that 60% of counties nationwide do not have a psychiatrist and 30% do not have a psychologist, Epperson said it was time to think “outside the box” and embrace remote patient monitoring. I knew that, she said.

Epperson, head of psychiatry, and UCHealth partners have begun working with digital health companies created by mental health providers. Using HealthRhythms technology, the department has employed passive remote monitoring for 100 of her patients, and this year he plans to expand to 2,000. By tracking behavioral “vital signs” that describe wellness, such as sleep, physical activity, and socialization, the product can help a patient seven days before he realizes he’s having a problem, with 90% accuracy. Proven to be able to predict a person’s mental health crisis.

During the CU trial period, the provider received 19 critical alerts.

“This allows us to reach out to patients in real time and say, ‘How are you? Are you okay?'” Epperson said.

Seeing technology in action eased her concerns about relationships.

“Patients loved it because they felt more connected to their providers,” Epperson said.

Individualized therapy for mental health

Associate Professor Andrew Novick, MD, PhD, commented on his residency when a prominent neuroscientist commented that “hypothetical research has not yet had a truly meaningful clinical impact in psychiatry.” “The bubble has burst,” he said just before starting the

The first drugs used to treat depression were discovered by chance during trials for the treatment of tuberculosis and cancer in the 1950s. There are currently fewer than 30 drugs approved for major depressive disorder, but each of these is derived from two original drug classes.

Current options work for 6 out of 10 people.

To address the “gap” in our ability to help patients, Novick believes the latest science in the neurobiology of depression offers the best path forward.

“Animal studies show that psilocybin, the active ingredient in ‘magic mushrooms,’ can rapidly strengthen neural connections,” he said.

In humans, how and why psilocybin works is still unknown, but he and his team plan to use human research and partner with pharmaceutical companies interested in these new approaches.

Deep brain stimulation has ‘life-changing’ results for patients

Deep brain stimulation (DBS) targets specific areas of the brain via implanted electrodes to help regulate abnormal brain activity. It is usually used to treat Parkinson’s disease and movement disorders.

Obsessive Compulsive Disorder (OCD) is the only psychiatric disorder for which the U.S. Food and Drug Administration (FDA) has approved DBS as a treatment. OCD affects approximately 3% of the US population, less than 60% respond to standard treatments, and only 10% go into complete remission.

Although minimally invasive, this is a rare neurosurgical procedure and CU is one of the few centers offering the treatment. Since 2015, there have been only 400 surgeries worldwide. Because this is a brain surgery, it is for people who have tried everything and have not responded to standard treatments.

Rachel Davis, MD, associate professor of psychiatry, warns that DBS is not a cure. A good response is her 35% reduction in symptoms.

“A 35% reduction in symptoms means that someone who spent 12 hours a day on compulsions and was unable to leave the house could now spend 6 hours a day and attend school with great support. So it can really impact quality of life,” she said.

DBS helps CU doctors find relief from OCD

Moksha Patel, M.D., Assistant Professor of Hospital Medicine, has faced a lifelong battle with severe OCD. He underwent DBS and experienced life-changing results.

“For me, OCD was everywhere. It affected every part of my life,” he said.

I tried all the evidence-based treatment options, but nothing helped. He gave up his hopes until he tried DBS.

“The rare but effective miracle of brain surgery changes your reality,” he said.

Can DBS help people with substance use disorders?

Methamphetamine use disorders affect 1.5 million people and are responsible for many overdose deaths. There are currently no drugs approved by the FDA.

Only three patients worldwide have undergone DBS for methamphetamine substance use disorder. The results are encouraging to Joe Sakai, M.D., an addiction psychiatrist and associate professor. He recently received support to study five of his patients over the next two years.

“We want to push the boundaries of what we can do and really develop what we hope will be more effective,” he said.

If the trial’s results prove promising, the National Institute on Drug Abuse has committed to funding a large crossover study of 20 people over three years.

“We are trying to develop an evidence base to support the use of DBS in this area,” said Sakai.

Guest Contributor: Carie Behounek is a writer specializing in healthcare and science.