Miller, quien es neurocientífica, dijo que consultó a varios psiquiatras y recibió receta tras receta de distintos medicamentos. Durante dos años, probó cuatro antidepresivos y dos antipsicóticos. Nada de eso ayudó hasta que su doctor de atención primaria notó niveles altos de un marcador autoinmune en su sangre.

Un especialista luego le hizo “todas las pruebas posibles”, dijo Miller. Finalmente, la diagnosticaron con la enfermedad autoinmune lupus y le recetaron un esteroide para reducir la inflamación. Algunos de sus síntomas mejoraron en cuestión de horas. Su depresión disminuyó poco después.

“Estaba convencida de que era un efecto placebo”, dijo Miller, “pero luego siguió funcionando”.

¿Había contribuido la inflamación a sus problemas de salud mental todo el tiempo? Miller cree que sí, aunque no puede saberlo con certeza. Sus psiquiatras nunca mencionaron esa posibilidad, dijo.

En la mayoría de las especialidades médicas, los doctores pueden confirmar si deben seguir un tipo de tratamiento mediante pruebas, como análisis de sangre, estudios de imagen y biopsias. Sin embargo, los trastornos mentales históricamente se han diagnosticado y tratado en base a síntomas visibles. Eso podría cambiar.

En la Asociación Americana de Psiquiatría incluyó ideas sobre cómo podría incorporar biomarcadores —indicadores biológicos de enfermedad mental que pueden aparecer en pruebas diagnósticas— en futuras versiones de su Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM, por sus siglas en inglés).

El DSM, a veces llamado por su influencia en el campo, proporciona criterios de diagnóstico. Lo utilizan clínicos que evalúan a pacientes y aseguradoras para decidir si cubren la atención.

Se necesita investigación “coordinada”

Los biomarcadores psiquiátricos aún no están listos para un uso generalizado, enfatiza el documento. Los científicos han investigado el tema por décadas, con pocos resultados. Se necesita más investigación para demostrar que estas mediciones son lo suficientemente válidas y confiables para usarse en la atención de pacientes, señala el documento de la asociación, y otros investigadores han planteado dudas sobre cómo su uso podría afectar los costos de la atención médica, la cobertura y la privacidad de los pacientes.

Agregar biomarcadores al DSM sería “algo muy importante”, dijo Jonathan Alpert, autor del documento de enero y vicepresidente del Comité Estratégico del Futuro del DSM de la asociación profesional.

El acceso a resultados de pruebas, junto con los síntomas, podría agilizar las decisiones de cobertura de seguros y ayudar a los clínicos a hacer diagnósticos y recomendaciones de tratamiento más rápidos y precisos, dijo. Si la biología de los pacientes sugiere que responderán mejor a un tratamiento que a otro, el doctor podría comenzar de inmediato con esa opción.

Actualmente, recetar medicamentos psiquiátricos puede ser “algo incierto”, ya que los clínicos no pueden predecir si funcionarán en un paciente en particular, dijo Matthew Eisenberg, director del Centro de Políticas de Salud Mental y Adicciones de la Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins.

En de principios de la década de 2000 financiado por el Instituto Nacional de Salud Mental, alrededor del 30% de los participantes con depresión vieron desaparecer sus síntomas con su primer tratamiento antidepresivo. Ese estudio sigue siendo uno de los ensayos más sólidos realizados sobre antidepresivos, aunque investigadores que menos personas se curan con estos medicamentos de lo que sugieren sus resultados.

Este enfoque de prueba y error puede llevar a recetas ineficaces e innecesarias, un tema criticado por defensores del movimiento Make America Healthy Again, encabezado por el secretario del Departamento de Salud y Servicios Humanos (HHS), Robert F. Kennedy Jr.

Kennedy ha sido especialmente , al vincularlos con la violencia después de sin evidencia y culpar a los doctores por recetar en exceso medicamentos a niños.

El HHS está analizando tendencias en diagnósticos y recetas psiquiátricas y evaluando enfoques alternativos de tratamiento en salud mental, con especial atención en niños, dijo la vocera Emily Hilliard en un comunicado. Hilliard no respondió a una pregunta sobre comentarios previos de Kennedy.

Los biomarcadores ya se utilizan para guiar tratamientos en otras áreas médicas, como la oncología. Arizona, Georgia, Kentucky, Texas y exigen que las aseguradoras cubran este tipo de pruebas. También se utilizan análisis de sangre y estudios de imagen para ayudar a diagnosticar la enfermedad de Alzheimer.

La Asociación Americana de Psiquiatría incluyó en su artículo varias formas en que los biomarcadores psiquiátricos podrían usarse en el futuro, como pruebas de actividad cerebral, perfiles genéticos o marcadores inmunológicos asociados con ciertas condiciones psiquiátricas, incluidas la esquizofrenia y las adicciones.

En la depresión, por ejemplo, alrededor de una cuarta parte de los pacientes tiene niveles elevados de una proteína inflamatoria llamada proteína C reactiva, que puede detectarse mediante un análisis de sangre. Las que las personas con niveles altos de esta proteína parecen responder mejor cuando reciben medicamentos que modifican los niveles de dopamina en el cerebro, en lugar de usar solo inhibidores selectivos de la recaptación de serotonina (ISRS), un tipo común de antidepresivo.

La proteína C reactiva aún necesita ser “validada de manera sólida” como biomarcador, según el documento de la APA, pero es una de las opciones más prometedoras bajo estudio.

Se necesita un esfuerzo de investigación “coordinado y bien financiado” para lograr esa validación, escribió la asociación, lo cual es incierto ya que la administración Trump recortó el financiamiento para investigación.

Solo al Instituto Nacional de Salud Mental se le cancelaron en 2025 al menos 128 subvenciones, por un valor de casi $173 millones, según en la revista JAMA. Aunque desde entonces algunas subvenciones han sido restauradas, los investigadores que dependen de fondos federales aún temen recortes.

“Hay una gran necesidad de financiamiento continuo y activo para la investigación relacionada con la salud mental”, dijo Alpert, pero los científicos tendrán que enfrentar “incertidumbres en el panorama de financiamiento”.

Efectos en cobertura y costos

Los costos de la atención médica entre pacientes con enfermedades mentales mal controladas, como hospitalizaciones, consultas ambulatorias y medicamentos. Algunas investigaciones sugieren que las pruebas de biomarcadores podrían ahorrar dinero al encontrar tratamientos adecuados más rápido y evitar algunos de estos costos.

Unestimó que las pruebas para identificar componentes genéticos que pueden influir en la efectividad de un medicamento podrían ahorrar al sistema de salud de Canadá $956 millones en 20 años si se aplican en adultos con depresión mayor en British Columbia., de investigadores españoles, encontró que estas pruebas redujeron costos para la mayoría de los 188 participantes con enfermedad mental grave.

No se sabe si ocurriría lo mismo en el sistema de salud de Estados Unidos. A corto plazo, dijo Eisenberg, un enfoque que use biomarcadores podría aumentar el gasto en atención médica debido al costo de las pruebas.

Las aseguradoras podrían negarse a cubrir pruebas de biomarcadores costosas, agregó. “Toma tiempo demostrar que la nueva evidencia científica es segura y efectiva”, dijo Eisenberg. “Y una vez que lo es, las aseguradoras no la cubren de inmediato”.

Algunos investigadores han expresado preocupación de que aseguradoras o empleadores puedan discriminar a personas cuyos perfiles biológicos sugieren riesgo de desarrollar afecciones neuropsiquiátricas graves.

Es un “momento crítico” para considerar enfoques legislativos que protejan a los pacientes y capaciten a los clínicos sobre cómo usar estas herramientas de manera adecuada, dijo Gabriel Lázaro-Muñoz, miembro del Centro de Bioética de la Escuela de Medicina de Harvard.

“No creo que el campo de la psiquiatría esté listo en este momento para manejar esto”, dijo.

El sistema de salud mental no está listo para “avanzar por completo”, dijo Andrew Miller, profesor de psiquiatría y ciencias del comportamiento en la Facultad de Medicina de la Universidad Emory, quien estudia la depresión relacionada con la inflamación. Pero la adopción de biomarcadores por parte de la asociación de psiquiatría marca “el inicio de una revolución”, dijo.

“Esto es un reconocimiento… de que lo que hemos hecho hasta ahora no ha sido suficiente”, dijo Miller. “Y podemos hacerlo mejor”.

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Miller, a neuroscientist, said she saw several psychiatrists and got prescriptions for drug after drug. Over two years, she tried four antidepressants and two antipsychotics. None of that helped — until her primary care doctor noticed high levels of an autoimmune marker in her blood.

A specialist then ran “every test in the book,” Miller said. Eventually, she was diagnosed with the autoimmune disease lupus and prescribed an inflammation-lowering steroid. Some of her symptoms let up within hours. Her depression subsided not long after.

“I was convinced it was a placebo effect,” Miller said, “but then it kept working.”

Had inflammation been contributing to her mental health problems all along? Miller thinks so, although she can’t know for sure. Her psychiatrists never raised that possibility, she said.

In most medical specialties, doctors can confirm whether to pursue a type of treatment through tests, such as blood work, imaging, and biopsies. Mental illnesses, however, have historically been diagnosed and treated based on outward symptoms. That could change.

The American Psychiatric Association included ideas for how it might incorporate biomarkers — biological indicators of mental illness that could show up on diagnostic tests — into future versions of its Diagnostic and Statistical Manual of Mental Disorders.

The DSM, sometimes because of its influence in the field, provides criteria for diagnoses. It’s used by clinicians assessing patients and by insurance companies deciding whether to cover care.

‘Coordinated’ Research Needed

Psychiatric biomarkers are not ready for widespread use yet, the paper emphasized. Scientists have researched the topic for decades, with little to show for it. More research is needed to prove these metrics are valid and reliable enough to be used in patient care, the APA’s paper said, and other researchers have raised questions about how their use could affect health care costs, insurance coverage, and patient privacy.

Adding biomarkers to the DSM would be “a very big deal,” said Jonathan Alpert, an author of the January paper and vice chair of the APA’s Future DSM Strategic Committee.

Access to test results, along with symptoms, could streamline insurance coverage decisions and help clinicians make faster and more accurate diagnoses and treatment recommendations, he said. 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, said Matthew Eisenberg, director of the Center for Mental Health and Addiction Policy at the Johns Hopkins University Bloomberg School of Public Health.

In a funded by the National Institute of Mental Health, about 30% of the study’s participants with depression saw symptoms disappear with their first antidepressant treatment. That study is still one of the most robust antidepressant trials conducted — although researchers have that fewer people are cured by these medications than its results suggest.

Such a trial-and-error approach can lead to ineffective and unnecessary prescriptions, a topic of attack by proponents of the Make America Healthy Again movement, spearheaded by Health and Human Services Secretary Robert F. Kennedy Jr. Kennedy has been especially , having linked them to violence after a without evidence and blaming doctors for overprescribing medications for children.

HHS is analyzing psychiatric diagnosis and prescription trends and evaluating alternative mental health treatment approaches, with a particular focus on children, spokesperson Emily Hilliard said in a statement. Hilliard did not respond to a question about Kennedy’s previous comments.

Biomarkers are already used to guide treatment in other medical disciplines, such as oncology. Arizona, Georgia, Kentucky, Texas, and require insurers to cover such testing. Blood and imaging tests are now used to help diagnose Alzheimer’s disease as well.

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. 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. C-reactive protein still needs to be “robustly validated” as a biomarker, according to the APA’s paper, but it’s among the most promising currently under investigation.

A “coordinated, well-funded” research effort is needed to achieve such validation, the APA wrote — a tenuous prospect since the Trump administration slashed funding for research.

The National Institute of Mental Health alone had at least 128 grants, worth almost $173 million, canceled in 2025, according to a . Though some grants have since been restored, researchers relying on federal money still fear their work is vulnerable to cuts.

“There’s a great need for continued, active funding of research related to mental health,” Alpert said, but scientists will have to grapple with “uncertainties of the funding landscape.”

Ripple Effects on Coverage, Costs

Health care costs among patients with poorly controlled mental illnesses, like hospital visits, outpatient appointments, and prescriptions. Some research suggests biomarker testing could save money by landing on the right treatments faster and avoiding some of these costs.

estimated that testing to look for genetic components that may influence a drug’s effectiveness could save the Canadian health system $956 million over 20 years if used among adults with major depression in British Columbia. , by Spanish researchers, found that such testing reduced costs for most of the 188 participants with serious mental illness.

Whether the same would be true in the U.S. health care system is unknown. In the short term, Johns Hopkins’ Eisenberg said, an approach that uses biomarkers could raise health care spending due to the costs of testing.

Insurers may decline to cover pricey biomarker tests, he added. “It takes a while for new science to be proven safe and effective,” Eisenberg said. “And once it is, insurance companies don’t cover it immediately.”

Some researchers have raised concerns that insurers or employers could discriminate against people whose biological profiles 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, said Gabriel Lázaro-Muñoz, a member of Harvard Medical School’s Center for Bioethics.

“I do not think that the field of psychiatry is currently ready to manage this,” he said.

The mental health system isn’t ready to “jump in with both feet,” said Andrew Miller, a professor of psychiatry and behavioral sciences at the Emory University School of Medicine, who studies inflammation-related depression. But the APA’s embrace of biomarkers signals “the beginning of a revolution,” he said.

“This is a recognition … that what we’ve done up to this point has not been good enough,” Miller said. “And we can do better.”

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Her request for coverage had been denied, the letter said, because she’d had a body mass index of less than 35 when she started Zepbound. The 25-year-old who lives in New York had been taking Zepbound without incident for months, so she was confused: Why was her BMI, which had been around 32 when she started, becoming an issue only now?

Wensley had no interest in quitting an effective drug. “Going right off like that, it’s easier said than done,” she said.

Her doctor fought to keep her on the GLP-1 agonist, the category that includes weight loss and Type 2 diabetes drugs Ozempic, Wegovy, Mounjaro, and Zepbound. But Wensley ultimately had to switch from Zepbound to Wegovy to meet her plan’s requirements. She said she doesn’t like Wegovy as much as her old medication, but she now feels lucky to be on any GLP-1.

Lots of research suggests such medications must be used indefinitely to maintain weight loss and related health benefits. But with list prices of , public and private payers are struggling to keep up with for GLP-1 weight loss drugs and in some cases are eliminating or restricting their coverage as a result.

North Carolina Medicaid plans to for weight loss on Oct. 1, just over a year after starting the coverage. Pennsylvania is planning to limit Medicaid coverage to beneficiaries at the highest risk of complications from obesity. And despite of a potential federal pilot program to extend coverage of GLP-1 obesity drugs under Medicaid and Medicare, all state Medicaid programs are likely to be under pressure due to in the budget reconciliation package recently signed into law by President Donald Trump.

Already, many GLP-1 users , — often due to side effects, high costs, or insurance issues. Now a growing number of researchers, payers, and providers are exploring deliberate “deprescription,” which aims to taper some patients off their medication after they have taken it for a certain amount of time or lost a certain amount of weight.

The U.K.’s National Institute for Health and Care Excellence, which creates guidance for the , on the use of some weight loss medications, such as Wegovy. And the concept was raised in a recent Institute for Clinical and Economic Review to obesity drugs.

, who directs the Center for Value-Based Insurance Design at the University of Michigan, that if some people using GLP-1s to lose weight were eventually transitioned off, more people could take advantage of them.

“If you’re going to spend $1 billion or $100 billion, you could either spend it on fewer people for a long period of time, or you can spend it on a lot more people for a shorter period of time,” he said.

Fendrick’s employer, the University of Michigan, indeed does that. Its prescription drug plan caps coverage of GLP-1 drugs if they’re used solely for weight loss.

Jamie Bennett, a spokesperson for Wegovy and Ozempic maker Novo Nordisk, declined to comment on the concept of deprescription, noting that its drugs are intended for chronic conditions. Rachel Sorvig, a spokesperson for Zepbound and Mounjaro manufacturer Eli Lilly, said in a statement that users should “talk to their health care provider about dosage and duration needs.”

Studies have shown that people typically regain within a year of , and that many people who quit ultimately go back on the drugs.

“There’s no standard of care or gold standard on how to wean right now,” said , an obesity and internal medicine doctor with UK HealthCare in Kentucky.

But the math shows why time-limited coverage is appealing to payers that struggle to pay for beneficiaries’ GLP-1 prescriptions, said , chief medical officer for the pharmacy benefit manager CVS Caremark.

And states are “between a rock and a hard place,” said Kody Kinsley, who until January led North Carolina’s Health and Human Services Department. “They’re going to have to look at every single thing and trim dollars everywhere they can.”

Pennsylvania was looking for cost-saving strategies even before the new federal tax-and-spending law, according to Brandon Cwalina, press secretary for the state’s Department of Human Services. Pennsylvania projects it will spend $1.3 billion on GLP-1 drugs this year.

Plans could see real savings, Fendrick said, if they covered GLP-1s for initial weight loss then moved people to cheaper options — such as more affordable drugs or behavioral health programs — to maintain it.

Plenty of companies are eager to sell insurers, employers, and individuals on behavioral alternatives. One is , its nutrition-focused weight management program as “a proven approach for deprescribing GLP-1s when clinically appropriate.” assessed 154 people with Type 2 diabetes who stopped using GLP-1 medications but continued following Virta’s program, concluding that their weight did not significantly increase after a year.

Researchers affiliated with a European weight management company also that slowly tapering off the medications may help maintain weight loss.

For employers and insurers, the “initial question” was whether to cover GLP-1s for obesity, said Virta CEO Sami Inkinen. “Now, basically, everyone’s coming to the middle and asking, ‘How do we responsibly cover these drugs?’”

Part of responsible coverage, Inkinen said, is providing other forms of support to patients who stop using GLP-1 medications, by choice or otherwise.

For some people, however, maintaining weight loss without a GLP-1 remains a challenge, even with other options available.

Lily, who lives in Michigan, lost almost 80 pounds in roughly 18 months on Wegovy. But she had to quit the drug when she turned 26 and left her parents’ insurance plan this year. The plan her employer offers stopped covering GLP-1s for weight loss right around the time she joined.

Lily, who asked to be identified by only her first name because she is not out to her family as transgender, has tried other medications since then, and previously tried lifestyle programs to control her weight. But she said nothing works as well for her as Wegovy.

She has regained 20 pounds since going off the drug at the beginning of the year and worries that number will continue to rise, potentially contributing to future health problems.

“Just give people the drugs,” she said. “It seems cheaper and safer in the long run.”

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