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Type I or Type II Depression et al.2025-05-26

Psychiatry was until recently a laggard, but now can leapfrog to the front of the pack in medicine, and in wellness. It can do that by learning from and emulating other specialties. It can emulate cancer in its use of liquid biopsies and biomarkers. It can emulate cardiology in the multi-faceted use of electric, imaging and biological diagnostic modalities. And it can emulate diabetes as a framework to think about subtypes and management.

Here is the case for the latter. Type I diabetes is early onset, mostly endogenously driven, with a genetic or autoimmune component, held in check by treatments but hard to cure. Type II diabetes is later onset, mostly exogenously driven (poor diet and sedentary lifestyles), curable by medications but also by lifestyle changes.

The same is true for depression, there is a Type I Depression that is earlier onset, endogenously driven, with a genetic and possibly autoimmune component, held in check by treatments but hard to cure. And a Type II Depression, later onset, mostly exogenously driven (stressors and disappointments), curable by medications but also by lifestyle changes (dietary, exercise, counselling). Like with diabetes, in depression Type II is much more common than Type I, and the individual has more agency than they think they do. Lifestyle changes should be first line, with medications playing a secondary, supportive and temporary role.

In fact, this Type I/Type II framework can be applied more broadly to other psychiatric disorders. By gathering family history, personal history, biomarker testing, social determinants testing, psychological testing (nowadays easily done digitally, through an app), a clinician and patient can work as a team to identify if they are dealing with a Type II or a Type I problem, and be empowered to embark on a precise, personalized course of action that leads to a complete recovery, lasting remission, even cure. The science and tools are here to facilitate that (mindxsciences.com).