When tech met depression

“The advice I’d give to somebody that’s silently struggling is: You don’t have to live that way. You don’t have to struggle in silence. You can be un-silent. You can live well with a mental health condition, as long as you open up to somebody about it, because it’s really important you share your experience with people so that you can get the help that you need.”

By Demi Lovato

Just last week, a study involving thousands of people has identified two potential gut microbes that might be linked to depression.

In particular, by studying how genetics and diet can affect the microbiome and analysing data from a large 40-year-effort health and lifestyle study from Finland, a group of scientists at Baker Heart & Diabetes Institute realised that two loci in the human genome (one containing a gene for digesting the milk sugar lactose and the other one gene that helps specify the blood type) can strongly influence which microbes are present in our gut.

Then, by exploring how these genetic variants (affecting the abundance of certain microbes) were linked to common diseases, the researchers made the connection between increased levels of two bacteria (Morganella and Klebsiella) and patients undergoing depression.

Depression affects over 300 million people worldwide (regardless of culture, age, gender, religion, race or economic status); is one of the most debilitating conditions on the world, with severe depression rated in the same disability category as terminal stage cancer; and encompasses Major Depressive Disorder and its related mood disorders including bipolar disorder, postpartum depression, post-traumatic stress syndrome, anxiety disorder and suicide.

We know that genetics plays a big role, since having a parent with depression increases the risk of depression. But, the rates of depression are higher also among those who have a history of substance use. While other factors linked to depression include brain chemistry imbalances, hormones, seasonal changes, stress and trauma.

In particular regarding depression and trauma, a work recently published by Katharina Schultebraucks and colleagues in JAMA Psychiatry that utilized data (between 1992 and 2010) from the Health and Retirement Study and collected also genetic information, concluded that the genetic information allowed reasonably accurate predictions of which depressive pattern an individual experienced following a major life stressor.

Today there are several very effective treatment options available for depression such as:

• Therapy: Behavioural activation, Cognitive-behavioural therapy, Interpersonal therapy, Problem-solving therapy, Psychodynamic therapy, Social skills therapy and Supportive counselling.
• Medications: Esketamine, Monoamine oxidase inhibitors, Norepinephrine and dopamine reuptake inhibitors, Selective serotonin reuptake inhibitors, Serotonin and norepinephrine reuptake inhibitors, Tricyclic antidepressants, and Pamelor.
• Cannabis and psychedelics.
• Lifestyle changes: Diet, Exercise and Stress management.
• Mental Health Apps (41 Mental Health Apps That Can Make Life a Little Easier)
• Prescription Digital Therapeutics (or PDTs, are a new therapeutic class), software programs that physicians prescribe as a form of treatment.
• Decoding Microbiome and monoclonal microbials (probiotic-based drugs). And
• Neuromodulaton.

Regarding drugs for depression currently in development, a new study published on February 15, 2022 in the Journal of Psychopharmacology, indicated that "Two doses of psilocybin may ease depression symptoms for up to 12 months", and Sage Therapeutics and Biogen Inc said that their "Depression drug meets main goal in late-stage study". So, Sage plans to start submitting data for US approval of the drug for major depressive disorder since zuranolone was generally well-tolerated with no new safety concerns.

But, let's see now some tech solutions, we currently have, for depression:

Limbix is the creator of SparkRx, a prescription digital therapeutic utilising the principles of cognitive behavioural therapy to address depression in young people aged between 13 and 22. SparkRx was released in October 2021 as part of the FDA’s relaxed regulatory requirements for digital health devices treating psychiatric disorders during the pandemic. In 2021, Limbix presented data demonstrating treatment with SparkRx digital therapeutic, showed clinically meaningful reductions in depressive symptoms in adolescents. The therapeutic is available on a smartphone and it guides you through mood tracking, behavioural activation, problem solving and mindfulness and features a supportive robot guide. Adolescent psychology experts aided in the design of Spark Rx.

Psious is developing a platform allowing the therapists to see what the patient sees in the virtual realty (VR) environment in real-time while receiving data on the patient’s level of distress so the simulation can be adjusted accordingly. The platform helps patients fight many mental conditions including fears, stress, addiction, anxiety and depression.

NeuroSigma (KT Corporation has made a $5 million equity investment in NeuroSigmain in 2021) developed Monarch eTNS System, a noninvasive electroceutical device for stimulating the trigeminal nerve, the largest of the cranial nerves that is responsible for sensations in the face and motor functions (biting and chewing) and also projects directly or indirectly to areas of the brain involved in ADHD, epilepsy and depression. This therapy (composed of a cell-phone sized pulse generator and a single-use electric patch that is applied to the forehead) is the first device-based, non-drug therapy approved by the FDA to treat pediatric ADHD. The investment will be used to fund the commercialisation of the eTNS System in the US, the development of the next generation of the eTNS device, additional clinical studies, and the application for expanded regulatory approvals in the US and other territories.

Neuronetics is developing a medical device for non-invasive therapies that address psychiatric and neurological disorders by using magnetic stimulation. In 2008, they were first to market with an FDA cleared depression treatment and since then they’ve treated more than 1 million people nationwide. The FDA-cleared, non-drug, noninvasive treatment for people with depression, Neuronetics’ NeuroStar® Advanced Therapy system is today’s leading TMS treatment for major depressive disorder.

Spring Health offers what it calls "precision mental healthcare" by matching each employee to the most effective care for them. The solution includes mindfulness and meditation, care navigation, coaching, therapy and medication management. Spring Health, aims to take the company global and expand its solution to serve employees' entire families, boosted by $190 million in fresh capital last year. The funding round propelled the company's valuation to $2 billion, according to executives.

Bark Technologies is developing a parental control phone tracker app using ML, to monitor all the major messaging and social media platforms on a child’s phone for signs of issues like cyberbullying, sexting, depression and suicidal thoughts.

Pear Therapeutics is developing clinically validated software-based therapeutics for multiple therapeutic areas, including severe psychiatric and neurologic conditions. The startup’s two marketed products are 12-week digital CBT programs, treating opioid use disorder and other substance abuse problems (both received FDA clearance last year). Pear Therapeutics, just announced the acquisition of two new digital therapeutic assets, from Waypoint Health Innovations, LLC and a researcher named Fredrik Holländare of Örebro University, that are designed for the treatment of a spectrum of depression conditions.

Moodnotes, recognises the user’s mood (negative) by asking insightful questions to determine the user’s thought patterns such as generalising, emotional reasoning or perhaps needless worrying. The app responds with some gentle encouragement to help the user develop healthier mental perspectives, decrease anxiety and improve well-being. 

Flow Neuroscience (raised over €7.9 million in 2021) is developing a brain stimulation headset (and an app) that can treat depression without medication. It is Europe’s first (and only) medically approved, at-home treatment of its type for depression. The Flow headset uses transcranial direct current stimulation (tDCS), a mild electrical signal, to stimulate and rebalance neural activity. The device sends gentle electrical signals to the frontal cortex of the brain which activates brain cells. In a trial, 23% of users managed to completely overcome depression and 41% felt significantly better after six weeks of using the headset alone. Possible side effects include light short-term headaches and itchy or tingly sensations on the forehead.

Meru Health, a 12-week app-based digital therapeutic program for people with depression, anxiety and/or burnout, that includes a HRV-biofeedback device (basically a heart rate monitor) that connects to the app via Bluetooth just announced it has joined Evernorth's national behavioural health provider network. Evernorth is the health service business of Cigna Corporation, so, Meru's services are now available to all Cigna health plan customers.

Cerebral (was valued at $4.8 billion last year) is a mental health telemedicine company that offers comprehensive care and medication management online for anxiety and depression. It offers a subscription, which includes video visits with a prescribing provider who manages medication plans, an assigned care manager who provides psychosocial support, medication, and medication delivery. But last month, Meta and TikTok pulled advertisements from Cerebral, saying that they have found the ads promoted negative body images and contained misleading health claims, for claiming that "obesity is five times more prevalent among adults with ADHD", and stated that "getting treatment for the mental health disorder could help patients stop overeating".

Brainsway's proprietary Deep Transcranial Magnetic Stimulation (Deep TMS™) platform to improve health and transform lives, is the first and only TMS company to obtain three FDA-cleared indications backed by pivotal studies demonstrating clinically proven efficacy. Brainsway's treatment was approved by the FDA for Major Depressive Disorder patients.

Magtism is global leader in neuroscience research and treatment for mental health that developed the first (Transcranial magnetic stimulation) TMS system more than 30 years ago and there have been close to 16,000 published studies citing the use of Magstim Stimulators in neuroscientific and clinical research. On November 02, 2021, they have been awarded 510K clearance for Horizon 3.0, that is offering enhanced workflows with navigated TMS and analytics. Horizon 3.0 integrates Magstim StimGuide+, which adds new layers of quality control analytics and workflow improvements to the first FDA-cleared TMS navigation system designed for the clinical setting.

Sentio's first technology product, Feel, is the world's first emotion sensor and mental health advisor that provides 24/7 continuous objective monitoring and real-time coaching. Feel, is an emotion-sensing wristband and app, for individuals that suffer from anxiety and depression and consists of 4 parts: Feel Emotion Sensor, Feel App, Feel Therapist and Educational Program. Sentio Solutions launched in 2020 the Feel Relief Program, a four-week, fully remote mental health support program which will be available to anyone experiencing increased stress or uncertainty.

UpLift (last year raised $8 million in a funding round led by B Capital Group) provides a comprehensive digital program for depression based on the principles of Cognitive Behavioural Therapy, by connecting patients with in-network therapists and mental health providers, either virtually or in-person. Therapists can also work with UpLift to find clients and manage their schedules.

Finally, Marigold Health (this month they announced $6m in seed funding) is developing chat support groups that connect behavioural health experts with patients to provide them with 24/7 access to support, for depression, PTSD, grief and substance abuse. Aside from the online chats, the app also lets users connect with their moderators and other group members via VoIP group phone conversations. However, the most important feature of the app is the patented language monitoring system which uses natural language processing to monitor group chats and put a stop to any potentially dangerous interactions in real time.

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You don’t have to be positive all the time. It’s perfectly okay to feel sad, angry, annoyed, frustrated, scared and anxious. Having feelings doesn’t make you a negative person. It makes you human.”

By Lori Deschene