Major Change Coming in Mental Health Diagnoses: Psychiatrists Explore Biomarkers

The American Psychiatric Association is considering a significant shift in mental health diagnoses by exploring the incorporation of biomarkers into future editions of its Diagnostic and Statistical Manual of Mental Disorders (DSM). This could revolutionize how mental illnesses are diagnosed and treated.

Currently, mental illnesses are primarily diagnosed and treated based on outward symptoms. In most medical specialties, doctors can confirm whether to pursue a type of treatment through tests, such as bloodwork, imaging and biopsies. Mental health has historically lacked such objective measures.

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

Adding biomarkers to the DSM would be a very big deal, according to experts. Access to test results, along with symptoms, could streamline insurance coverage decisions and help clinicians make faster and more accurate diagnoses and treatment recommendations. If patients' biology suggested they'd respond better to one treatment than another, their doctor could waste no time in starting there.

Currently, prescribing psychiatric medications can be a bit of a crapshoot, with clinicians unable to predict whether they will work for a particular patient. In a seminal, early 2000s trial funded by the National Institute of Mental Health, about 30% of participants with depression saw symptoms disappear with their first antidepressant treatment.

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.

However, psychiatric biomarkers are not ready for widespread use yet. More research is needed to prove these metrics are valid and reliable enough to be used in patient care. A coordinated, well-funded research effort is needed to achieve such validation, though the Trump administration has slashed funding for research.

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

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.

The mental health system isn't ready to jump in with both feet, but the APA's embrace of biomarkers signals the beginning of a revolution. This is a recognition that what has been done up to this point has not been good enough, and the field can do better.

In related mental health news, more than one in three Americans (38%) are planning mental health-related New Year's resolutions for 2026, marking a 5% increase from the previous year. However, nearly 30% of Americans acknowledge that mental health struggles are a significant barrier to achieving their goals for 2026.