Personalized approaches help treat depression

Translating the findings from clinical trials into tools that clinicians can use to help make decisions about treating depression — that’s the goal of research by Dr. Helena Kim, a postdoctoral researcher with the Centre for Addiction and Mental Health and the University of Toronto.

There’s a gap between the growing discoveries from mental health research and how these discoveries are applied to patient care, Kim says. Decision-making algorithms (called “decision trees”) can help pinpoint which treatment changes can help which patients. This approach is often called “personalized medicine,” and it is being used in many areas of patient care. With Kim’s research, treatment of depression joins the list.

Her research is funded through the Mach-Gaensslen Foundation Fellowship in Mental Health, Addictions and Cognitive Health, awarded by the Canadian Institutes of Health Research (CIHR). She has completed the first of two years of research.

The fellowship was a good fit for Kim’s patient-oriented research, whereas other CIHR grants are focussed more on basic research. “This is another example of how the Mach-Gaensslen Foundation of Canada can make a difference,” says Dr. Christopher Carruthers, chair of the foundation’s board. “We can fund research that is critical and immediately applicable in the clinical setting but doesn’t fit existing categories for other research funding.”

Applying research results in patient care

Kim looks at studies with data sets consisting of patients with depression. Findings from the studies — about risk factors, the success of treatment approaches, and outcomes — can give physicians guidance on how best to help their patients.

“There are different predictors for different dilemmas and different patient groups,” says Kim. This is why the existing “rules of thumb” may not provide the best answers. “There is no one-size-fits-all,” says Kim.

To date, Kim has developed three decision trees for “hard-to-treat” or “complex” depression.

The first drew from a study of more than 1300 adults with major depressive disorder who didn’t see much improvement even after four weeks of treatment with an antidepressant medication. The decision tree answers questions such as, should the treatment continue longer? Should the dose be increased? Or should the patient switch to another antidepressant?

The research showed that a few clinical factors predicted the effectiveness of staying on an antidepressant, increasing the dose, or switching to a new drug. Among these were better or poorer physical health and post-traumatic stress disorder. Looking for such predictors can help clinicians make the best choice to help their patients.

Another tree helps decide the best approach for patients with major depressive disorder who also drink alcohol often (“at-risk” drinking). Drawn from a study that included more than 140 patients with both problems, it looks at which is best — care from a single physician or “collaborative care” with non-physicians providing additional care over the telephone.

The decision tree indicates which type of care is suited to which patients. The number of drinks the patient is taking per week emerged as a factor in the decision.

Her third decision tree involved patients who have depression late in life and are not responding to an antidepressant. Such patients are at risk of suicide or can lose their ability to function in daily life. Thus, the aim is to help them improve quickly, before depression takes a toll.

The data for this decision tree were from a study of 742 patients in whom different medication regimens were tried. It looks at such questions as, does adding one of two antidepressants studied to the first drug improve outcomes? Or does switching to another antidepressant work better?

How many drugs the patient had already tried proved to be a factor in deciding whether to add a drug to the patient’s regimen or switch to a new drug. The patient’s age and severity of depression (determined by a commonly used questionnaire) also had an effect on the decision to add a drug or switch.

Kim says decision trees are simple to use, easily deployable, and scalable. They can be incorporated into day-to-day practice to help clinicians make well-informed decisions. And, of course, they can help relieve depression for patients effectively and quickly.

The research agenda for next year

During the second year of her fellowship, Kim plans to develop more decision trees, this time for non-drug treatments. She will draw from a study of psychotherapy for depression during the period before and after childbirth, as well as studies of brain stimulation techniques, including repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS).

She also wants to incorporate “biomarkers” into decision trees. Biomarkers are a patient’s biological differences, such as a genetic difference or the way they metabolize drugs, usually determined by blood tests. The effect of biomarkers on responses to medications has been explored in previous research.

Once she has designed decision trees, Kim’s next step is to test how feasible and useful they will be in clinical practice. But that’s a story for her next research grant.

For more details about the research and decision trees, see Dr. Helena Kim’s presentation.

Dr. Lena Palaniyappan wins the 2025 Royal-Mach-Gaensslen Prize

The Mach-Gaensslen Foundation of Canada is happy to announce that Dr. Lena Palaniyappan is the winner of the 2025 Royal-Mach-Gaensslen Prize, sponsored jointly by the foundation and the University of Ottawa Institute for Mental Health Research at The Royal.

“Prevention is the Holy Grail” for serious mental illnesses such as psychosis and schizophrenia, says Palaniyappan. Targeting prevention to the young people at risk and understanding how these serious illnesses start and affect people is the aim of his research, conducted at the Douglas Mental Health University Institute in Montreal.

“These illnesses start really early, in adolescence or sometimes even in childhood,” he says. “So any intervention has to start really early.” Finding the people at risk and putting methods in place to prevent psychosis is important, he says. Factors such as the COVID-19 pandemic have worsened youth mental health in general and are expected to result in more psychosis in future.

“If we can even delay these illnesses by five or ten years” patients would benefit, he says. Young people could grow to be adults, completing schooling, finding a spouse and so on, and be better equipped to cope with any mental illness.

Palaniyappan has recently brought together people with lived experience of mental illness as well as advocacy groups to create the Centre of Excellence in Youth Mental Health. He is one of Canada’s and the world’s top schizophrenia researchers, constantly conducting and publishing studies with new insights into the disease.

These include his studies of the “rich emotional signals” in human speech, which may help predict psychotic episodes. He is also using powerful magnets (7-Tesla imaging) to measure chemicals in the brain. For example, 7-Tesla scanners can show the neurochemical glutamate in the brain, which may help researchers determine how it affects certain symptoms of psychosis.

But all of his work is grounded in the experiences of patients and their families and communities. At the Centre of Excellence, all research is discussed with councils representing young people and their parents, who guide the research. “We pick the [research] questions that are dear to the hearts of patients and families.”

Palaniyappan’s achievements will be celebrated at the Royal-Mach-Gaensslen Prize event January 29, 2026, at The Royal in Ottawa. For more information, see The Royal’s website.

A new survey will help find and fill gaps in communities’ ability to help those at end of life and their caregivers

To improve the experience of death and dying in Canada — both for those at the end of their lives and for their caregivers, friends and family — we need to build knowledge and support services in their communities. But where should we devote time and money to best help people?

Answering this question is the purpose of the Death Literacy Index (DLI), a survey to understand many aspects of people’s skills, knowledge and awareness around death and dying (“death literacy”). The survey was designed in Australia and first released in 2020, as part of the “compassionate communities” approach to foster communities’ ability to provide palliative and end-of-life care.

The survey has been adapted for use in the UK, Ireland, Sweden, China and Turkey to date.

Now, it’s being adapted to the Canadian context, thanks to funding from the Mach-Gaensslen Foundation of Canada.

“It’s a significant tool in helping an individual or community identify their gaps in what they know about death and dying,” says Dr. Nick Busing, who is on the board of Compassionate Ottawa, the project’s sponsor, and an emeritus professor of family medicine at the University of Ottawa. The survey shows whether respondents know about resources in their community or have experience at the bedside of someone dying, among many other aspects. “Institutions like hospitals could use a tool like this to understand where their employees are in relation to death and dying,” he mentions as an example.

“At the moment, we don’t have anything as a measure of death literacy in Canada,” explains Christine McPherson, a psychologist, nurse and associate professor at the University of Ottawa, who is leading the research.

As a result, she says, there’s a gap when organizations try to find ways to improve people’s knowledge and skills. Information to fill this gap can help guide policy, allocate funding and determine whether efforts to improve death literacy are effective.

“For example, do we put more money into advance directives?” she asks. “The survey will show where the gaps are — what people know, what they don’t, and what support they still need. For example, do we know how to plan for serious illness, to make sure our wishes are known? Do we know what funeral directors do? Do we know what palliative care is and how to access it?”

“This work fits well with one of the three key areas of focus of the MGF — mental health,” commented Dr. Ian Arnold, a director of the Mach-Gaensslen Foundation of Canada. “Increasing our society’s ability to understand the key factors that affect how we deal with and react to the end of life is essential to managing this often-difficult life transition. This will make this transition easier for the individual dying, their family, and their friends and communities.”

Project progress

Adapting a survey is a complex process. McPherson says many steps are needed to ensure that the survey “actually does what it’s supposed to do.” On the one hand, Canada has similarities to countries like Australia, Ireland and the UK, where the survey is being used, such as our publicly funded universal health care system. But we have differences as well, such as medical assistance in dying and different provincial policies affecting palliative and end-of-life care. Canada’s communities are often very diverse, encompassing cultures with varying attitudes and approaches to death and dying.

These observations come from a pilot study on whether the DLI would be clinically useful in Canada. The team asked Canadians familiar with a public health approach to end-of-life care about the DLI. Respondents said the survey had potential if it were modified to the Canadian context.

To modify the survey, first, an advisory group was formed to interpret the findings from the pilot study and two subsequent consultations and apply these to a new Canadian version of the DLI. Several members of Compassionate Ottawa are serving on this group.

The next phase involves interviews with Canadians from diverse backgrounds, asking them to look at and comment on the original DLI survey. This phase is designed to determine the relevance of the survey’s content and its sensitivity to cultures that may have different values, beliefs and practices concerning death and dying. As of October 2025, recruitment of participants for these interviews has started.

A partner in these phases is the Canadian Hub for Applied and Social Research, a support and consulting service at the University of Saskatchewan. The hub recruits participants and collects and analyzes data.

With the information from the interviews about the survey’s relevance and sensitivity in hand, the advisory group will start to modify the survey for Canada. The first draft of a modified survey will be tested with a sample of Canadians to ensure the questions, response options and instructions are clear to users. Based on this testing, the survey will be further modified.

Once that phase is completed, the survey will be rigorously tested in a larger sample of Canadians and the responses analyzed.

In adapting a survey like the DLI, “you want the tool to measure what it’s supposed to be measuring and to ensure it’s accurate in measuring that,” often referred to as “validity,” McPherson says. It’s also important that a survey is reliable in measuring across different people and groups — that is, it measures people’s skills, knowledge and awareness in a consistent way.

Survey open for use across Canada

The researchers plan to release the finalized survey freely on the website of the University of Ottawa, so that anyone in Canada can use it. The team will also present the survey to academic audiences and grassroots organizations. “We want to get it out there so people can use it,” says McPherson.

The ultimate goal, says McPherson, is “trying to make sure people have knowledge, skills, awareness before something happens and it becomes a crisis.”

“Too often we avoid talking about death, dying and bereavement until it happens to us.”

Compassionate Ottawa will start using the survey when it’s ready, say McPherson and Busing.

“An organization like Compassionate Ottawa could use the survey results to target some of our interventions or workshops,” says Busing.

Even community organizations may not fully understand the community’s needs, says Busing. “We may have blinkers on. We don’t have the entire picture. So that’s what we need to fill in.”

He believes the survey will help groups like Compassionate Ottawa to do that. He foresees “ongoing, continuous needs assessment for the community related to these critical issues around death and dying,” for the benefit of caregivers and the entire community.

For the third year, the Mach-Gaensslen Foundation of Canada is supporting the Dr. Francis Wayne Quan Memorial Prize for the best papers published in the Journal of Psychiatry and Neuroscience (JPN) over the year. The prize-winning papers for 2024 were announced April 23, 2025. This year, three papers were awarded gold, silver and bronze awards:

Gold

Heli Tuppurainen, Sara Määttä, Mervi Könönen, Petro Julkunen, Hannu Kautiainen, Soile Hyvärinen, Olli Vaurio, Mikko Joensuu, Matti Vanhanen, Kati Aho-Mustonen, Esa Mervaala and Jari Tiihonen

Navigated and individual α-peak-frequency–guided transcranial magnetic stimulation in male patients with treatment-refractory schizophrenia

J Psychiatry Neurosci March 01, 2024, 49 (2), E87-E95; https://doi.org/10.1503/jpn.230063

The editorial board chose this paper from Finland that advances knowledge in transcranial magnetic stimulation (TMS). This randomized trial studied a 3-week course of repetitive TMS, individualized based on the α-peak-frequency of different patients, as an adjunctive therapy in men with schizophrenia that had not responded to other treatment. The patients experienced symptom improvement, which was sustained for at least three months following treatment, showing the promise of individualized α-peak-frequency TMS in patients with treatment-resistant schizophrenia.

Silver

Sophie Simard, Reza Rahimian, Maria Antonietta Davoli, Stéphanie Théberge, Natalie Matosin, Gustavo Turecki, Corina Nagy and Naguib Mechawar

Spatial transcriptomic analysis of adult hippocampal neurogenesis in the human brain

J Psychiatry Neurosci October 16, 2024, 49 (5), E319-E333; https://doi.org/10.1503/jpn.240026

The editorial board chose this Canadian paper in fundamental science of the human brain. The study examines neurogenesis — the process by which new neurons are formed — in the hippocampus in healthy humans. This understanding will allow researchers to examine how neurogenesis might be altered by chronic stress, mental illness, or pharmacological treatment.

Bronze

Jinsong Tang, Qiuxia Wu, Chang Qi, An Xie, Jianbin Liu, Yunkai Sun, Tifei Yuan, Wei Chen, Tieqiao Liu, Wei Hao, Xu Shao and Yanhui Liao

Widespread reductions in cortical thickness following ketamine abuse

J Psychiatry Neurosci May 30, 2024, 49 (3), E182-E191; https://doi.org/10.1503/jpn.230111

The editorial board chose this paper from China that examines a possible risk of long-term use of ketamine for treatment of depression. Low-dose ketamine and esketamine have revolutionized short-term treatment for major depression and suicidality but can have dissociative adverse effects. This study examined whether cortical thickness was altered in the brains of ketamine users compared to controls and found widespread reductions throughout the brain.

About the Prize

Dr. Francis Wayne Quan Memorial Prize is co-sponsored by the Mach-Gaensslen Foundation of Canada and JPN. The prize was launched in January 2022 to honour the contributions of psychiatrist and former editor Dr. Francis Wayne Quan to the foundation and the journal.

Dr. Quan, who died 9 August 2021 after a brief battle with kidney cancer, was one of the founders and the first managing editor of the Psychiatric Journal of the University of Ottawa, the predecessor of JPN, from 1976 to 1983. He was also a director of the Mach-Gaensslen Foundation of Canada from 2016 to his death. These experiences were among Dr. Quan’s many contributions during his busy career as an eminent psychiatrist in Ottawa. The Mach-Gaensslen Foundation of Canada would like to congratulate this year’s prize winners. For more information about the winning papers, see the announcement in JPN.