"Digital Therapeutics" in psychiatry

[justabanana]

I recently stumbled on the concept of digital therapeutics. I had no idea what it was, but the person who told me about it said its essentially apps that are FDA approved and required a prescription from a doctor to use. They explained to me that it was a bit of an oversimplification, but that's what it boiled down to. I found this article that really got me intrigued:

Digital therapeutics: Preparing for takeoff | McKinsey

Here's a company who has a product used for substance abuse that's approved by the FDA:
https://peartherapeutics.com/science/product-pipeline/


So I do some quantified self type of stuff. Occasionally track my calories and workouts. I track my sleep every night. I have a once daily mood tracker where I input if I ate healthy or unhealthy, and I also log whether I drank alcohol, exercised, and meditated. Being able to look back over my weeks/months makes it easy to see when the bad habits are creeping in or the good habits are falling by the wayside. I've imagined myself telling future patients to track things like this so I could get a better idea of their sleep hygiene, alcohol use, and other habits.

Looking at a screenshot of the substance abuse app, it essentially looked like a cravings tracker which is something which already exists in the app store, but obviously has never been put into any clinical trials. The app for schizophrenics is intended to increase medication compliance. They really just seem like simplified extensions of the quantified self movement. A part of me thinks this is a cash grab, but another part of me thinks that monetizing these tools is a legitimate way to test their clinical usefulness and get providers to use them.

What are your thoughts on this? Will the act of making it 'prescription' encourage providers to use these techniques/apps? Have you incorporated anything along these lines into your practice?

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[When is graduation again?]

I recently stumbled on the concept of digital therapeutics. I had no idea what it was, but the person who told me about it said its essentially apps that are FDA approved and required a prescription from a doctor to use. They explained to me that it was a bit of an oversimplification, but that's what it boiled down to. I found this article that really got me intrigued:

Digital therapeutics: Preparing for takeoff | McKinsey

Here's a company who has a product used for substance abuse that's approved by the FDA:
https://peartherapeutics.com/science/product-pipeline/


So I do some quantified self type of stuff. Occasionally track my calories and workouts. I track my sleep every night. I have a once daily mood tracker where I input if I ate healthy or unhealthy, and I also log whether I drank alcohol, exercised, and meditated. Being able to look back over my weeks/months makes it easy to see when the bad habits are creeping in or the good habits are falling by the wayside. I've imagined myself telling future patients to track things like this so I could get a better idea of their sleep hygiene, alcohol use, and other habits.

Looking at a screenshot of the substance abuse app, it essentially looked like a cravings tracker which is something which already exists in the app store, but obviously has never been put into any clinical trials. The app for schizophrenics is intended to increase medication compliance. They really just seem like simplified extensions of the quantified self movement. A part of me thinks this is a cash grab, but another part of me thinks that monetizing these tools is a legitimate way to test their clinical usefulness and get providers to use them.

What are your thoughts on this? Will the act of making it 'prescription' encourage providers to use these techniques/apps? Have you incorporated anything along these lines into your practice?

I actually started coding apps during med school, so I've seen how the health/wellness app market operates first hand. Honestly, I think the idea of prescribed therapeutics is iffy, but there is some opportunity for benefit. Most developers on IOS and Android are relatively inexperienced with the health side of things and are in it for the cash-grab, so you end up with a ton of carbon copies of existing things. That's why there are tons of fitness trackers, mood diaries, and alcohol abstinence trackers like the app you mentioned above.

As far as FDA approval, new apps that would be developed by mental health providers would be locked out of the digital therapeutics market 2/2 inability to afford the FDA fees and not really being able to pay for research to prove efficacy. I think it could be a great idea to prescribe apps if the app actually brings something new to the table, but most people either wouldn't download the app or would find a cheaper/free version of the app of the App stores. The FDA approval would satisfy some skeptical providers/physicians, but I'm not sure the consumer/patient would care.

Personally, as a resident, for all apps I'm working on, I'm going out of my way to avoid marketing them as medical devices to avoid needing FDA approval and lawsuits. It's fairly straightforward to word app descriptions to where they kind of describe treating depression/anxiety without actually writing it as a treatment... Though I miss out on downloads I could get if I went straight for the mental illness diagnoses.

 

[WisNeuro]

The modal patient needs a herculean effort to get them to program their phone to simply remind them to take their medication twice a day. I don't see the majority doing data entry in an app on a regular basis. You'll get the highly motivated patients on board, but these are people who would do well with pretty much any evidence based intervention.

 

[clausewitz2]

The modal patient needs a herculean effort to get them to program their phone to simply remind them to take their medication twice a day. I don't see the majority doing data entry in an app on a regular basis. You'll get the highly motivated patients on board, but these are people who would do well with pretty much any evidence based intervention.

You'd be surprised how many very high functioning people are walking around with past episodes suggestive of bipolar I or a cycloid psychosis. These folks often don't want to have anything to do with therapy and would like to have their meds managed and not talk too much about what happened, thank you very much. not an ideal recovery style, but it also might be why you guys on the therapy side of things don't see them that much. they might well benefit from it for symptom tracking to see if a pre-emptive adjustment might need to be made to their current regimen.

I agree generally that these are not likely to add much value for most people.

 

[WisNeuro]

You'd be surprised how many very high functioning people are walking around with past episodes suggestive of bipolar I or a cycloid psychosis. These folks often don't want to have anything to do with therapy and would like to have their meds managed and not talk too much about what happened, thank you very much. not an ideal recovery style, but it also might be why you guys on the therapy side of things don't see them that much. they might well benefit from it for symptom tracking to see if a pre-emptive adjustment might need to be made to their current regimen.

I agree generally that these are not likely to add much value for most people.

Definitely, the highly motivated, therapy averse people would probably benefit somewhat from this. But, these people probably benefit from most comprehensive plans discussed with providers. I just think that the digital revolution in psychology/psychiatry is overhyped as the populations that most need the services are the least likely to benefit from it.