Psychiatry has been standing on the sidelines while oncology and other medical fields have advanced precision medicine. The goal of my research group, the Unit for Biological and Precision Psychiatry at Lund University, is to change this trajectory and word towards “precision psychiatry”. Tailored interventions based on biomarkers and symptom profiles does not only lead to greater efficacy and improved health outcomes, but can also reduce costs (avoiding expenditure on treatment of individuals who will not respond) and improve risk-benefit relationships (avoiding toxicity in people who likely would not benefit from a treatment). Our overreaching aim is to identify biomarkers of antidepressant treatment response and use novel clinical trial designs to redefine the Diagnostic and Statistical Manual of Mental Disorders-based categorical definition of depression into smaller, more homogenous, subgroups that are more likely to respond to specific mechanism-based treatments. In this talk, I will provide examples of ongoing and completed antidepressant clinical trials that use novel study designs including predictive enrichment and match/mismatch approaches. We hope that such approaches could be small pieces of the precision psychiatry puzzle that we and many others are trying to solve.

Classical psychedelics in general and psilocybin in particular has emerged as a potential new class of antidepressants, based on the resluts reported from several small unclontrolled long term follow ups and two larger acute effect RCTs.

Preclinical data suggest the meachanism of action of these drugs to involve rapid generation of novel synapses in eg PFC.

This talk will give a representative overview of the research to-date, and also present preliminary results from PSIPET, a small, single center, double-blind, parallel group RCT of psilocybin in the treatment of remitting MDD.

Pharmacological treatment of pregnant women with depression balances between the woman and her fetus: Untreated maternal depression may negatively influence fetal - and later child brain development and could lead to maternal morbidity and mortality. On the other hand, psychiatric medication may influence the developing fetal brain. The talk will view this dilema from a clinical perspective while giving an overview of the existing literature. The aim is not to give answers but to discuss aspects of the difficult decisions pregnant women with depression may face.