Tag: antidepressants

Transforming Mental Illness Diagnosis and Treatment with Biomarkers

In this article I discuss potential use of biomarkers to diagnose and treat psychiatric disorders, particularly depression. Research is underway to identify these which could improve diagnosis and treatment, though concerns about cost, insurance, and privacy persist. Adequate funding for research is crucial.

This information is current as of the date of original publication or update but may have changed by the time you read this. Do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with a qualified healthcare professional.

Imagine you consult a physician for a problem. The doctor asks you questions and examines you. Then you have blood tests, cultures, X-rays,a CT scan or MRI. You hope these tests show what is “wrong” so the doctor can treat you.

But what if all the tests are “normal”? Normal tests suggest that your symptoms may be due to a cause for which there is no biomarker.

A biomarker is a diagnostic test that indicates a specific disease or condition.

biomarker-A biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease.

Both physicians and patients would like a biomarker for every disease. But many common conditions do not yet have a biomarker.

These include migraine, fibromyalgia, irritable bowel syndrome, Parkinson’s disease, many skin conditions, Alzheimer’s dementia, depression, and other psychiatric disorders.

a female physician talking to a male patient

For these disorders, physicians make a “clinical diagnosis”.

clinical diagnosis-The process of identifying a disease, condition, or injury based on the signs and symptoms a patient is having and the patient’s health history and physical exam

Much of medical research is devoted to finding biomarkers for these and other conditions. This article from KFF focuses on finding biomarkers for psychiatric disorders, especially depression. Such tests could be helpful not only for diagnosis but also for guiding therapy.

But there are potential downsides, like cost, insurance coverage, privacy, and potential discrimination, as explained in the article.

Psychiatrists’ Use of Biomarkers Could Open a New Window Into Mental Health Diagnoses

by Jamie Ducharme, March 17, 2026

Amanda Miller was 30 and pregnant with her second child in Hershey, Pennsylvania, when she developed depression. After she gave birth, her depression worsened. It was joined by a slew of unexplained health problems.

Miller, a neuroscientist, said she saw several psychiatrists and got prescriptions for drug after drug. Over two years, she tried four antidepressants and two antipsychotics. None of that helped — until her primary care doctor noticed high levels of an autoimmune marker in her blood.

A specialist then ran “every test in the book,” Miller said. Eventually, she was diagnosed with the autoimmune disease lupus and prescribed an inflammation-lowering steroid. Some of her symptoms let up within hours. Her depression subsided not long after.

“I was convinced it was a placebo effect,” Miller said, “but then it kept working.”

Had inflammation been contributing to her mental health problems all along? Miller thinks so, although she can’t know for sure. Her psychiatrists never raised that possibility, she said.

Laboratory vs Clinical Diagnosing

In most medical specialties, doctors can confirm whether to pursue a type of treatment through tests, such as blood work, imaging, and biopsies. Mental illnesses, however, have historically been diagnosed and treated based on outward symptoms. That could change.

The American Psychiatric Association in a January paper included ideas for how it might incorporate biomarkers — biological indicators of mental illness that could show up on diagnostic tests — into future versions of its Diagnostic and Statistical Manual of Mental Disorders.

Diagnostic and Statistical Manual of Mental Disorders.

The DSM, sometimes called “psychiatry’s bible” because of its influence in the field, provides criteria for diagnoses. It’s used by clinicians assessing patients and by insurance companies deciding whether to cover care.

‘Coordinated’ Research Needed

Psychiatric biomarkers are not ready for widespread use yet, the paper emphasized. Scientists have researched the topic for decades, with little to show for it.

More research is needed to prove these metrics are valid and reliable enough to be used in patient care, the APA’s paper said, and other researchers have raised questions about how their use could affect health care costs, insurance coverage, and patient privacy.

Adding biomarkers to the DSM would be “a very big deal,” said Jonathan Alpert, an author of the January paper and vice chair of the APA’s Future DSM Strategic Committee.

Access to test results, along with symptoms, could streamline insurance coverage decisions and help clinicians make faster and more accurate diagnoses and treatment recommendations, he said. If patients’ biology suggested they’d respond better to one treatment than another, their doctor could waste no time in starting there.

A Prescribing “Crapshoot”

Currently, prescribing psychiatric medications can be “a bit of a crapshoot,” with clinicians unable to predict whether they will work for a particular patient, said Matthew Eisenberg, director of the Center for Mental Health and Addiction Policy at the Johns Hopkins University Bloomberg School of Public Health.

In a seminal, early 2000s trial funded by the National Institute of Mental Health, about 30% of the study’s participants with depression saw symptoms disappear with their first antidepressant treatment. That study is still one of the most robust antidepressant trials conducted — although researchers have more recently argued that fewer people are cured by these medications than its results suggest.

9 different medication pills and capsules of various colors

Such a trial-and-error approach can lead to ineffective and unnecessary prescriptions, a topic of attack by proponents of the Make America Healthy Again movement, spearheaded by Health and Human Services Secretary Robert F. Kennedy Jr. Kennedy has been especially critical of antidepressants, having linked them to violence after a mass shooting without evidence and blaming doctors for overprescribing medications for children.

HHS is analyzing psychiatric diagnosis and prescription trends and evaluating alternative mental health treatment approaches, with a particular focus on children, spokesperson Emily Hilliard said in a statement. Hilliard did not respond to a question about Kennedy’s previous comments.

Biomarkers are already used to guide treatment in other medical disciplines, such as oncology. Arizona, Georgia, Kentucky, Texas, and more than a dozen other states require insurers to cover such testing. Blood and imaging tests are now used to help diagnose Alzheimer’s disease as well.

A Future for Psychiatric Biomarkers

The APA included in its article a variety of ways psychiatric biomarkers could be used in the future — such as testing for brain activity, genetic profiles, or immune markers associated with certain psychiatric conditions, including schizophrenia and substance use disorders.

In depression, for example, about a quarter of patients have elevated levels of an inflammatory protein, called C-reactive protein, that can be found through a blood test.

Research has shown that people with high levels of this protein seem to respond better when given drugs that alter dopamine levels in the brain, rather than using only selective serotonin reuptake inhibitors, or SSRIs, a common type of antidepressant.

C-reactive protein still needs to be “robustly validated” as a biomarker, but it’s among the most promising currently under investigation.

APA

A “coordinated, well-funded” research effort is needed to achieve such validation, the APA wrote — a tenuous prospect since the Trump administration slashed funding for research.

The National Institute of Mental Health alone had at least 128 grants, worth almost $173 million, canceled in 2025, according to a research letter in the journal JAMA. Though some grants have since been restored, researchers relying on federal money still fear their work is vulnerable to cuts.

“There’s a great need for continued, active funding of research related to mental health,” Alpert said, but scientists will have to grapple with “uncertainties of the funding landscape.”

Ripple Effects on Coverage, Costs

Health care costs tend to be higher among patients with poorly controlled mental illnesses, due to expenses like hospital visits, outpatient appointments, and prescriptions. Some research suggests biomarker testing could save money by landing on the right treatments faster and avoiding some of these costs.

One modeling study estimated that testing to look for genetic components that may influence a drug’s effectiveness could save the Canadian health system $956 million over 20 years if used among adults with major depression in British Columbia. Another study, by Spanish researchers, found that such testing reduced costs for most of the 188 participants with serious mental illness.

Whether the same would be true in the U.S. health care system is unknown. In the short term, Johns Hopkins’ Eisenberg said, an approach that uses biomarkers could raise health care spending due to the costs of testing.

Insurers may decline to cover pricey biomarker tests, It takes a while for new science to be proven safe and effective,
And once it is, insurance companies don’t cover it immediately.”

Matthew Eisenberg, Johns Hopkins

“The Beginning of a Revolution”

Some researchers have raised concerns that insurers or employers could discriminate against people whose biological profiles suggest they’re at risk of developing serious neuropsychiatric conditions.

It’s a “critical moment” to consider legislative approaches to protect patients and train clinicians about how to appropriately use these tools, said Gabriel Lázaro-Muñoz, a member of Harvard Medical School’s Center for Bioethics.

“I do not think that the field of psychiatry is currently ready to manage this,” he said.

The mental health system isn’t ready to “jump in with both feet,” said Andrew Miller, a professor of psychiatry and behavioral sciences at the Emory University School of Medicine, who studies inflammation-related depression. But the APA’s embrace of biomarkers signals “the beginning of a revolution,” he said.

“This is a recognition … that what we’ve done up to this point has not been good enough,” Miller said. “And we can do better.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Depression

Depression is common among people who have a chronic disease such as cancer or diabetes. Fortunately, depression is treatable even if you have another medical illness or condition. Learn more about chronic disease and depression: Caring for your mental health #shareNIMH

Biomarkers in Cancer Care

Biomarker testing is a way to look for genes, proteins, and other substances (called biomarkers or tumor markers) that can provide information about cancer. Each person’s cancer has a unique pattern of biomarkers.

Some biomarkers affect how certain cancer treatments work. Biomarker testing may help you and your doctor choose a cancer treatment for you.

There are also other kinds of biomarkers that can help doctors diagnose and monitor cancer during and after treatment. To learn more, visit the Tumor Markers fact sheet.

Biomarker testing is for people who have cancer. People with solid tumors and people with blood cancer can get biomarker testing.

The FDA-approved blood tests for diagnosing Alzheimer’s disease

In May 2025, the U.S. Food and Drug Administration (FDA) approved the first blood test as a tool to help diagnose Alzheimer’s disease. The test is called Lumipulse.

The test measures certain proteins, including a specific form of the tau protein. This can indicate amyloid plaques in the brain, a protein that is considered the hallmark sign of Alzheimer’s disease.

This blood test, along with other diagnostic tools can help diagnose Alzheimer’s disease. While the blood test can detect changes even before memory problems begin, it is only recommended for use in people showing symptoms of Alzheimer’s disease.

The test is still being refined and can’t diagnose Alzheimer’s disease on its own. 

What to Remember from this Post

I learned from the KFF article and the references, did you? What are your takeaways from what you read? Here are some to consider.

  • Doctors use laboratory tests and imaging to supplement information gleaned from talking to and examining patients.
  • Biomarkers for common conditions make diagnosis easier and more precise, and help guide therapy.
  • Discovery of biomarkers for other serious conditions will help patients get earlier diagnosis and more effective treatment. More research is needed.
  • New medical discoveries introduce trade-offs in cost, payment, benefit, and potential misuse.

How will you use what you’ve learned? How may you apply this information to a current or future health concern?

What more information do you need and where will you find it?

a stethoscope, a red heart and a heart ekg tracing
exploring the HEART of HEALTH

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Understanding Seasonal Affective Disorder (SAD): Symptoms and Treatments

This new post shares information about Seasonal Affective Disorder (SAD) affecting many individuals as daylight hours decrease, causing depressive symptoms that vary between winter and summer patterns. Treatment options include light therapy, psychotherapy, antidepressants, and vitamin D supplements. It’s essential to seek help from healthcare providers if experiencing signs of SAD, which can impact mood and behavior.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

This information is current as of the date of original publication or update but may have changed by the time you read this. Do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with a qualified healthcare professional.

Photo by Katie Harp on Pexels.com

Many of us turned our clocks back one hour this month (if they didn’t change automatically) as Daylight Saving Time ended. Daylight hours are fewer now and will be until the first day of winter, December 21, when they will get progressively longer until next spring.

Many people feel “down” or have the “winter blues” when the days get shorter in the fall and winter and feel better in the spring when longer daylight hours return. (That pattern will be reversed if you live in the southern hemisphere.)

Sometimes, these mood changes can affect how a person feels, thinks, and behaves. If you notice significant changes in your mood and behavior when the seasons change, you may be experiencing seasonal affective disorder (SAD).

Characteristics of SAD

SAD is a type of depression having a recurrent seasonal pattern, lasting about 4−5 months out of the year. The signs and symptoms of SAD include those associated with depression as well as other symptoms that differ for winter-pattern versus summer-pattern SAD.

Not every person with SAD experiences all the symptoms listed below. Learn about signs and symptoms of depression.

Symptoms of depression can include:

  • Persistent sad, anxious, or “empty” mood most of the day, nearly every day, for at least 2 weeks
  • Feelings of hopelessness or pessimism
  • Feelings of irritability, frustration, or restlessness
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy, fatigue, or feeling slowed down
  • Difficulty concentrating, remembering, or making decisions
  • Changes in sleep or appetite or unplanned weight changes
  • Physical aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause and do not go away with treatment
  • Thoughts of death or suicide or suicide attempts

For winter-pattern SAD, additional symptoms can include:

  • Oversleeping (hypersomnia)
  • Overeating, particularly with a craving for carbohydrates, which can cause weight gain
  • Social withdrawal ( “hibernating”)

For summer-pattern SAD, additional symptoms can include:

  • Trouble sleeping (insomnia)
  • Poor appetite, leading to weight loss
  • Restlessness and agitation
  • Anxiety
  • Violent or aggressive behavior

The depression associated with SAD is related to changes in daylight hours, not the calendar, so stresses associated with the holidays or predictable seasonal changes in work or school schedules, family visits, and so forth are not the same as SAD.

Learn about ways to get help and find a healthcare provider or access treatment.

The Substance Abuse and Mental Health Services Administration has an online treatment locator to help you find mental health services in your area.

Diagnosis of SAD

If you or someone you know is showing symptoms of SAD, talk to a healthcare provider or a mental health specialist about your concerns. They may have you fill out a questionnaire to determine if your symptoms meet the criteria for SAD.

To be diagnosed with SAD, a person must meet the following criteria:

  • They have the symptoms of depression or the more specific symptoms of winter- or summer-pattern SAD listed above.
  • Their depressive episodes occur during specific seasons (winter or summer) for at least 2 consecutive years. However, not all people with SAD experience symptoms every year.
  • Their depressive episodes during the specific season are more frequent than depressive episodes experienced at other times of the year.

Who develops SAD?

It is estimated that millions of Americans experience SAD, although they may not know they have this disorder. In most cases, SAD begins in young adulthood.SAD occurs more often in women than in men.

Winter-pattern SAD occurs more often than summer-pattern SAD and is more common in people living farther north, with shorter daylight hours in the winter. For example, people in Alaska or New England are more likely to develop SAD than people in Texas or Florida.

SAD is more common in people with depression or bipolar disorder, especially bipolar II disorder, which involves repeated depressive episodes and hypomanic episodes (less severe than the typical manic episodes of bipolar I disorder). They may have other mental disorders, such as attention-deficit/hyperactivity disorder, eating disorder, anxiety disorder, or panic disorder. Learn more about these disorders.

SAD sometimes runs in families and may be more common in people who have relatives with other mental illnesses, such as depression or schizophrenia.

What causes SAD?

The cause of SAD is still unknown but is being studied. Most research to date has investigated potential causes of winter-pattern SAD because it is more common and easier to study. As a result, less is known about summer-pattern SAD, and more research is needed.

Serotonin

Studies indicate that people with SAD, especially winter-pattern SAD, have reduced levels of the brain chemical serotonin, which helps regulate mood. Sunlight may affect levels of molecules that help maintain normal serotonin levels. Shorter daylight hours may prevent these molecules from functioning properly, causing lower serotonin levels in the winter.

Vitamin D

Vitamin D deficiency may exacerbate these problems in people with winter-pattern SAD because vitamin D is believed to promote serotonin activity. Our bodies produce vitamin D when exposed to sunlight on the skin. With less daylight in the winter, people with SAD may have lower vitamin D levels, further reducing serotonin activity.

Melatonin

Other studies suggest that both forms of SAD relate to altered levels of melatonin—a hormone important for maintaining the normal sleep−wake cycle. People with winter-pattern SAD produce too much melatonin, which can increase sleepiness and lead to oversleeping.

In contrast, people with summer-pattern SAD may have reduced melatonin levels, consistent with long, hot days worsening sleep quality and leading to depression symptoms. Longer daylight hours, shorter nights, and high temperatures can cause sleep disruptions. However, these theories have not been fully tested.

Both serotonin and melatonin help maintain the body’s daily rhythm tied to the seasonal night−day cycle. In people with SAD, changes in serotonin and melatonin disrupt normal daily rhythms so they can no longer adjust to seasonal changes in day length, leading to sleep, mood, and behavior changes.

Negative thoughts and feelings about the winter or summer and its associated limitations and stresses are also common among people with SAD (as well as others). It is unclear, however, whether these thoughts are causes or effects of the mood disorder, but they can be a useful focus of treatment.

Treatments for Seasonal Affective Disorder

Treatments are available to help people with SAD. They fall into four main categories that can be used alone or in combination:

  • Light therapy
  • Psychotherapy
  • Antidepressant medication
  • Vitamin D

Light therapy and vitamin D are treatments for winter-pattern SAD, whereas psychotherapy and antidepressants are used to treat depression in general, including winter- and summer-pattern SAD. There are no treatments specific to summer-pattern SAD.

Talk to a health care provider about the potential benefits and risks of different treatment options and which treatment is best for you. Find tips for talking with a health care provider to improve your care and get the most out of your visit.

Light therapy

Since the 1980s, light therapy has been a mainstay for treating winter-pattern SAD. It aims to expose people with SAD to a bright light to make up for the diminished natural sunlight in darker months.

For this treatment, the person sits in front of a very bright lightbox (10,000 lux) every day for about 30−45 minutes, usually first thing in the morning, from fall to spring. The light box, which is about 20 times brighter than ordinary indoor light, filters out the potentially damaging UV light, making this a safe treatment for most.

However, people with certain eye diseases or people taking certain medications that increase sensitivity to sunlight may need to use alternative treatments or use light therapy under medical supervision.

Light therapy lamp 10000 lux

Psychotherapy

Psychotherapy (also called talk therapy or counseling) can help people with SAD by teaching them new ways of thinking and behaving and changing habits that contribute to depression.

Cognitive behavioral therapy (CBT) is a type of psychotherapy aimed at helping people learn to challenge and change unhelpful thoughts and behaviors to improve their depressive and anxious feelings. CBT has been adapted for people with SAD (known as CBT-SAD).

CBT-SAD is typically conducted in two weekly group sessions for 6 weeks that focus on replacing negative thoughts related to the season, such as thoughts about the darkness of winter or the heat of summer, with more positive thoughts.

CBT-SAD also uses behavioral activation, which helps people identify and schedule pleasant, engaging indoor or outdoor activities to offset the loss of interest they typically experience in the winter or summer.

Photo by Photo By: Kaboompics.com on Pexels.com

When researchers directly compared CBT-SAD with light therapy, both treatments were equally effective in improving SAD symptoms—although some symptoms got better slightly faster with light therapy than CBT. However, a long-term study that followed SAD patients for two winters found that the positive effects of CBT seemed to last longer.

Learn more about psychotherapy.

Antidepressant medication

Medications used to treat depression (antidepressants) can be effective for SAD when used alone or in combination with talk therapy. Antidepressants work by changing how the brain produces or uses certain chemicals involved in mood or stress.

Antidepressants take time—usually 4−8 weeks—to work. Problems with sleep, appetite, and concentration often improve before mood lifts. You may need to try more than one medication to find the one that works best.

Because SAD, like other types of depression, is associated with disturbances in serotonin activity, antidepressant medications called selective serotonin reuptake inhibitors are sometimes used to treat symptoms. These medications can significantly enhance a person’s mood.

The U.S. Food and Drug Administration (FDA) has approved an antidepressant called bupropion in an extended-release form designed to last longer in the body. For many people, bupropion can prevent the recurrence of seasonal depressive episodes when taken daily from the fall through early spring.

All medications can have side effects. Talk to a healthcare provider before starting or stopping any medication. Learn more about antidepressants. Learn about specific medications like bupropion, including the latest approvals, side effects, warnings, and patient information, on the FDA website .

Ordinarily Well: The Case for Antidepressants

by Peter D. Kramer

“Dr. Kramer never loses sight of patients. He writes with empathy about his clinical encounters over decades as he weighed treatments, analyzed trial results, and observed medications’ influence on his patients’ symptoms, behavior, careers, families, and quality of life. He shows how antidepressants act in practice: less often as miracle cures than as useful, and welcome, tools for helping troubled people achieve an underrated goal—becoming ordinarily well.” (Amazon affiliate link)

Vitamin D

Because many people with winter-pattern SAD have vitamin D deficiency, vitamin D supplements may help improve symptoms. However, studies testing vitamin D as a treatment for SAD have produced mixed results, in some it is as effective as light therapy and others found no effect.

Talk to a healthcare provider about any dietary supplements and prescription or over-the-counter medications you are taking. Vitamin D can interact with some medications.

Prevention of SAD

Because the onset of SAD is so predictable, people with a history of the disorder might benefit from starting the treatments mentioned above before the fall (for winter-pattern SAD) or spring (for summer-pattern SAD) to help prevent or reduce depression symptoms. So far, few studies have investigated whether SAD can be prevented.

Discuss a personalized treatment plan with a healthcare provider. A provider can help you decide not only the best treatment option but also the best timing to help prevent SAD depressive episodes.

What are clinical trials and why are they important?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. These studies help researchers determine if a new treatment is safe and effective in people. The main purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

People volunteer for clinical trials for many reasons. Some people join clinical trials to help doctors and researchers learn more about a disease and improve health care. Other people, such as those with health conditions, join to try new or advanced treatments that aren’t widely available.

NIMH supports clinical trials at the National Institutes of Health campus in Bethesda, Maryland, and across the United States. Talk to a healthcare provider about clinical trials, their benefits and risks, and whether one is right for you. Learn more about participating in clinical trials.

I adapted this public domain content, from the National Institutes of Mental Health, National Institutes of Health, Department of Health and Human Services

Exploring the HEART of Health

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Dr. Aletha