Mental health treatment reimagined

The landscape of mental healthcare is at a critical juncture. While pharmacotherapy and talk therapy have long been the cornerstones of treatment, their limitations have become increasingly apparent, with one in eight people worldwide struggling with a mental disorder. Our lack of ability to treat these conditions creates a severe burden on those facing these challenges as well as society at large, calling for new ways to treat this crisis in mental health.  

This systemic failure underscores a pressing need for a fundamental paradigm shift away from the subjective, “one-size-fits-all” methodologies to more personalized, objective, and adaptive approaches to intervention. This review will argue that closed-loop brain-computer interfaces (BCIs) and other forms of neuromodulation, informed by the real-time dynamics of distributed brain networks, represent the most promising pathway to achieving this. High-resolution intracortical brain-computer interfaces (BCIs), in particular, could play an instrumental role in revealing neural circuits that are needed for a more personalized, precise mental health treatment.

Modern mental health treatments are limited

Today’s psychiatric care largely uses medications and talk therapy in a “one-size-fits-most” manner. Clinicians prescribe antidepressants, antipsychotics or anxiolytics and wait weeks or months to see if a patient senses improvement. This subjective treatment leaves clinicians guessing on what pharmaceutical to prescribe along with the correct dosage, leading to inefficient treatment. 

Typically only 60–70% of patients respond to first-line antidepressant therapy, and the same report indicates that about 10–30% of patients have treatment-resistant depression, failing multiple trials of different drugs. Among responders, nearly 30–40% still have significant residual symptoms, requiring additional treatments. Side effects are also common, and patients are often forced to abandon treatments as a result. Many patients are left cycling through multiple medications before finding partial relief, spending months in limbo while symptoms continue.

Crucially, there are no routine lab tests or monitoring devices for mental illnesses. Unlike diabetes (with glucose meters) or heart disease (with EKGs and blood pressure cuffs), psychiatry has no real-time neurological readouts to guide treatment. Psychiatrists still rely on interviews and self-report surveys, which suffer from recall bias, subjectivity and cultural influences. It is a long and imprecise process, with drug effectiveness evaluated slowly over the course of weeks using symptom checklists.

Shortcomings in psychiatry and mental health treatment leave a huge unmet medical need. In addition to patient suffering, a toll is placed on society with an estimated $5 trillion in economic losses globally from mental disorders. As the WHO puts it, “mental health has been one of the most overlooked areas of public health.” The message was made clear to former NIMH director, Thomas Insel, when a man, frustrated, stood up to speak during his talk:

“I have a 23-year-old son with schizophrenia. He’s been hospitalized five times. He’s been in jail three times. He made two suicide attempts. Look, man, you know, our house is on fire and you’re talking about the chemistry of the paint.”

Mental health needs better tools

In most areas of medicine, objective biomarkers guide diagnosis and therapy. We have glucose monitors for diabetes and EKGs for heart rhythm, for example, but psychiatry lacks similar measures. We can suspect depression or mania based on behavior and self-report, but we can’t measure it directly in the brain, in real time. We are effectively driving with a fogged windshield by focusing solely on patients’ memories of their moods or clinicians’ subjective impressions. These subjective rating scales are limited by the time it takes a person to recognize and label an emotion, and by recall bias, and even minor differences in culture or language can skew questionnaire results.

Some researchers have uncovered brain circuitry or neurotransmitters that can serve as biological indicators for mental health conditions like obsessive compulsive disorder (OCD), eating disorders and treatment-resistant depression (TRD). But progress is slow, partly because mental health conditions are incredibly complex and heterogenous, but also because current approaches rely on data from lower-resolution lower-channel count modalities. High resolution measures like intracortical spikes have been less explored in mental health treatment, but they may provide the circuit measures needed to make a difference, i.e. Intracortical BCI modules may be implanted across multiple brain regions, extracting valuable information across key areas involved in emotion, like the mesolimbic circuit. 

Ultimately, psychiatry currently relies on periodic office visits and retrospective surveys, with no continuous view of a person’s brain state. In the future, we want to provide that real-time perspective. We want to overcome this lack of helpful measurement and the vacuum of biomarkers to improve treatment and outcomes among nearly billions who are suffering. Finding a way to monitor a brain’s activity continuously, creating biological measures of mood, optimizing treatments on the fly with a dose before a relapse, or switching therapies as soon as a sign of non-response appears—all of this is possible with real-time, continuous measures of direct brain activity.

This is where intracortical BCIs hold the biggest promise for mental health. By tapping directly into brain networks with high fidelity, they could uncover biomarkers of anxiety, depression or psychosis as they happen. It could be a path to move psychiatry from guesswork to data-driven impact.

Intracortical BCIs open new possibilities for mental health care

Why focus on intracortical interfaces (tiny electrodes implanted in the brain) rather than noninvasive options like EEG or even implants on the brain surface (ECoG)? The answer is signal fidelity. EEG and ECoG are useful for large-scale patterns, but they miss the fine details of neural computation. An intracortical BCI, like Paradromics’ Connexus^® BCI, records the activity of individual neurons with industry leading data transfer rates. In practice, this is due to a greater access to individual neural firing activity compared to lower temporal and spatial resolution measures like EEG or ECoG. 

The major implication of intracortical BCI recordings is that they allow the discovery of new circuit-based biomarkers of psychiatric disease. Many mental illnesses are thought to arise from dysregulation in brain networks like the limbic system, frontal executive areas, or reward circuits, but common imaging measures like EEG and fMRI only provide a small window into the true underlying network dynamics within these areas. 

Intracortical BCIs could directly measure the firing rate and firing patterns of neural populations across critical neural circuits as patients process emotions or cues. We might find, for example, that a particular neural signature emerges just before a panic attack or a depressive episode, a discovery which would likely be missed with measurements that only happen sporadically, like when the patient visits the clinic.

This means tracking how brain states evolve minute by minute, day by day. Real-time tracking could enable monitoring how a patient’s brain responds immediately after taking an antidepressant, or how neural patterns fluctuate in response to stress. Just as a continuous glucose monitor alerts a diabetic to a rising blood sugar, a brain monitor could alert doctors to an emerging spike of anxiety or dysregulation, prompting preemptive therapy.

The high data throughput of Paradromics’ BCI platform could also contribute to a more personalized treatment for mental health and psychiatric disorders. Machine-learning decoders can help translate neural signals into meaningful health metrics, including enabling the ability to identify biomarkers unique to certain mental health conditions or states. 

Over time, further advancements in machine learning and artificial intelligence can be embedded within the platform to capture a fingerprint of the unique neural firing patterns for that particular individual. This could allow truly individualized neurotherapy: identifying which drug a patient is most likely to respond to, or when a safe dose is reached. Just like genomic profiling transformed oncology by stratifying patients by tumor type; intracortical BCIs could play a similar role in psychiatry by stratifying patients by circuit-level phenotypes or identifying patterns of hyper or hypoconnectivity.

Intracortical BCIs offer superior resolution, coverage and a real-time ability to identify and monitor potential brain-circuit biomarkers. With this rich data, we could move mental health assessment and treatment from vague symptom reports to concrete, objective brain-based metrics.

BCIs with neuromodulation can offer new ways to treat the mind

The power of intracortical BCI monitoring could be greatly magnified when combined with neurostimulation. Techniques like DBS, transcranial magnetic stimulation (TMS), and vagus nerve stimulation are already used experimentally for severe depression, OCD, and other disorders. But these have typically been “open-loop,” continuous, or scheduled somewhat arbitrarily based on the availability of the clinician.

Closed-loop designs have the potential to substantially improve the typical open-loop approach to neuromodulation by sensing the patient’s brain state and adjusting stimulation in real time. For example, a system might detect an early sign of a depressive episode and increase stimulation only at that moment, altering the neural circuit. While less well established in the area of depression, the approach has shown considerable advancements already in the area of movement disorders and epilepsy.

The real strength lies in pairing neuromodulation with robust cortical circuit measures through high-data-throughput BCIs. Intracortical BCIs could identify cortical circuit biomarkers of unhealthy mental states and guide timed control of robust stimulation techniques like DBS. In this case, the BCI serves as the brain’s “heartbeat monitor,” and the stimulator acts as a “pacemaker” for mental health. 

Eventually, applications could extend beyond mental disorders to everyday mental states, such as mood or attention. Intracortical electrode recordings have already shown that activity within limbic regions can be correlated with mood. Mood-related circuit activities could trigger a brief pulse of DBS to adjust the network accordingly and alter the patient's mental state. There is also evidence that controlled stimulation of the internal capsule or striatum can enhance cognitive control during a conflict task. 

Symptom-linked closed-loop biomarkers like this could enable the sort of personalized therapeutic treatments needed for complex psychiatric disorders, potentially improving symptom control with fewer side effects compared to modern pharmaceutical treatments. Neurostimulation and intracortical BCI monitoring could be the answer needed for the millions with debilitating mental health conditions. 

Closing the neurotherapy gap

Despite considerable advancements in BCI applications restoring speech and motor movement, the possibility of BCIs for psychiatric and mental health treatment applications are still speculative. The cortical patterns that may underlie mental health conditions, or fluctuations in mood or anxiety, have yet to be isolated in detail. Clearly, there is an innovation gap in terms of the potential circuit-level biomarkers that could be identified, and their role in assisting with mental health treatment for the many suffering. 

As one review bluntly states, a big reason psychiatry lags is “the lack of appropriate modalities for direct monitoring of brain function.” Without a high-resolution BCI, we are essentially blind to the neural dynamics that may underlie mental states and mental health conditions. To borrow an astronomy analogy: It’s like charting galaxies with binoculars instead of a telescope. Intracortical BCIs could be the missing telescope for the brain.

Why hasn’t this been done already? BCIs are just getting started within clinical settings, and the use cases have primarily focused on immediate needs like restoring movement and speech. As the technology continues to develop, allowing continuous high throughput brain state monitoring, additional applications in the area of mental health and psychiatry will be a natural next step. 

Mental healthcare faces a critical need for objective, data-driven tools that can bring it in line with other medical fields such as oncology and cardiology. Current treatments rely heavily on subjective reporting and indirect measures, which often fall short for many patients. BCIs offer a path forward by directly recording and interpreting brain activity at high resolution, creating the potential to establish robust neurological biomarkers. These advances could shift psychiatry from symptom-based assessments toward a deeper understanding of the neural circuits underlying mental illness.