A person diagnosed with depression may respond well to the first antidepressant prescribed, while another person with the same diagnosis may experience little improvement, troublesome side effects or repeated treatment failures. The same variability can be seen across anxiety disorders, bipolar disorder and schizophrenia. This uncertainty is one reason why precision psychiatry is emerging as an important area of mental-health research.
The concept recently gained attention in India after psychiatrist Dr Rahul Mathur discussed precision psychiatry at the recently held 18th World Congress of Biological Psychiatry in Jaipur, according to a report by India CSR. The approach seeks to understand why people with apparently similar psychiatric diagnoses can have very different biological and clinical profiles.
But precision psychiatry is not simply about ordering more tests or replacing psychiatrists with artificial intelligence. It is an evolving approach that combines a person's symptoms, medical history, genetics, brain biology, behaviour and environmental factors to potentially identify the treatment most likely to work for that individual.
With more than one billion people globally living with a mental disorder, according to the World Health Organization (WHO), the possibility of making psychiatric treatment more targeted could have major implications.
What is precision psychiatry?
Traditional psychiatric diagnosis largely depends on symptoms, clinical history and observation. These remain essential. However, diagnostic categories can contain people with very different underlying biological mechanisms.
Precision psychiatry attempts to look beneath the diagnostic label.
Researchers are investigating whether information such as genetic variations, brain-circuit activity, inflammatory and metabolic markers, sleep and circadian patterns, behavioural data and environmental exposures can help divide patients into more meaningful biological or clinical subgroups.
The ultimate goal is to improve three things: predicting who is at risk, identifying what is driving a person's symptoms and determining which treatment is most likely to help.
The US National Institute of Mental Health (NIMH) has identified biomarker development and precision assessment as major research priorities. Its Precision Psychiatry Initiative is specifically designed to develop biomarkers and quantitative tools that could eventually guide treatment decisions. Importantly, NIMH notes that there is currently no validated biological, physiological or behavioural test that can reliably select a depression treatment for an individual patient.
How could precision psychiatry work?
1. Genetics and pharmacogenomics
A person's genetic makeup can influence how medicines are metabolised. Variations in genes such as CYP2D6 and CYP2C19 can affect the way some antidepressants are processed in the body. The Clinical Pharmacogenetics Implementation Consortium (CPIC) has published guidelines explaining how certain genetic results may be used to guide dosing or selection of several serotonin-reuptake inhibitor antidepressants.
However, pharmacogenomic testing should not be confused with a genetic test that can simply identify the "right antidepressant". Genetics is one piece of information among many, and the clinical usefulness and cost-effectiveness of testing vary.
2. Brain imaging and neural circuits
Researchers are also studying whether brain activity can reveal biological subtypes of conditions such as depression and predict response to specific therapies. MRI and other neuroimaging techniques can identify differences in brain structure and functional connectivity. Recent research has explored whether particular patterns of brain-network activity could help predict response to antidepressants, psychotherapy or neuromodulation treatments.
A 2025 review in Neuropsychopharmacology found promising candidate biomarkers but also highlighted a major limitation: researchers still need larger studies capable of showing that a particular biomarker can distinguish between different first-line treatments.
3. Blood and other biological biomarkers
Scientists are studying inflammatory proteins, metabolic markers, hormones and other biological signals that may differ between patients. A recent review of prognostic biomarkers in precision psychiatry found potential signals involving inflammatory, metabolic, neuroendocrine and neurotrophic pathways, as well as genetic and epigenetic factors. But the authors also noted limited replication and methodological weaknesses in existing research.
This means that a blood test marketed as a definitive way to diagnose a psychiatric disorder or select a treatment should be viewed cautiously unless it has been properly validated.
4. Artificial intelligence and behavioural data
AI and machine learning are another major component of precision psychiatry. Researchers are analysing large datasets containing symptoms, medical records, cognitive measurements, genetics, brain scans and even behavioural information collected through digital devices.
The objective is to identify patterns that clinicians may not be able to detect from an individual consultation. NIMH's IMPACT-MH initiative, for example, aims to use behavioural measurements and computational methods to develop clinical signatures that could eventually support individual-level prediction and clinical decision-making. Further, in 2025, the Indian National Institute of Mental Health and Neuro-Sciences (NIMHANS) also launched PrecInNor in collaboration with the University of Oslo, Norway, to promote bidirectional precision psychiatry training in both nations.
Why does precision psychiatry matter?
Mental-health treatment can involve considerable uncertainty. Finding an effective medication or therapy may require adjustments over time, while some people experience inadequate response or side effects.
For depression in particular, treatment response varies substantially between individuals. Precision psychiatry could eventually help doctors reduce this uncertainty, avoid ineffective treatments and identify people at higher risk of relapse.
But the approach is not intended to replace the doctor-patient relationship. Psychiatric care will continue to require an understanding of a person's symptoms, relationships, circumstances, preferences and lived experience. Biology alone cannot explain the complexity of mental health.
What are the challenges?
The biggest challenge is validation. A biomarker may correlate with depression or treatment response in a research study without being accurate enough to guide decisions for an individual patient. Studies may also involve highly selected populations that do not represent the diversity seen in everyday clinical practice.
Researchers have therefore called for larger, prospective and diverse studies, along with real-world validation and careful assessment of fairness and cost. here are also concerns around privacy, genetic information, algorithmic bias, unequal access and the possibility of over-medicalising complex human experiences.
For India, affordability and access will be particularly important. A sophisticated technology that is available only in a handful of private centres cannot by itself transform mental healthcare for a population of more than a billion people.
Precision psychiatry could represent an important next step in mental healthcare: not abandoning psychiatric diagnosis, but making it more biologically informed and individually tailored. The science is promising, particularly in genetics, neuroimaging, biomarkers and AI-driven prediction. But it is not yet a finished clinical revolution. Most proposed biomarkers still require rigorous validation before they can reliably determine which treatment an individual patient should receive.
For patients, the practical message is simple: precision psychiatry is a developing field, not a magic test that can currently tell everyone which psychiatric medicine will work. Its real promise lies in gradually replacing trial-and-error treatment with better evidence about the biology and circumstances of each person.
Read More: Psychiatry's Diagnostic Manual May Soon Use Biology To Explain Mental Illness
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