Mental Illness Research, Education and Clinical Center of Excellence (MIRECC), VISN21, VA Palo Alto Health Care System
The Stanford Center for Precision Mental Health and Wellness has a close affiliation with VA. Our joint work on precision mental health for Veterans is focused around the Precision Medicine Core at the MIRECC, VA Palo Alto. This Precision Medicine Core is directly responsive to the priorities of the Veterans Affairs to develop and validate brain and mental health biomarkers among Veterans, with specific consideration for depression, anxiety, post-traumatic stress disorder, bipolar disorder and related conditions. This initiative may be referred to as the “Precision Medicine for Veterans Initiative”. It is the result of unrelenting advocacy and has became a public law, as the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, a bipartisan bill passed by the senate in 2019.
Within the Precision Medicine for Veterans Initiative, the methods include brain structure and function measurements, such as functional magnetic resonance imaging and electroencephalogram, and their integration with lab-based biomarkers and the Million Veterans Program.
The Precision Medicine Core serves to integrate, develop, and disseminate measurements of functional magnetic resonance imaging and electroencephalogram and demonstrate their utility as biomarkers for making more precise diagnoses and treatment choices. Biomarkers derived from these measurements show promise for improving the precision with which we can identify subtypes of depression, anxiety and post-traumatic stress, and the interventions that will be of most benefit for each subtype. The Precision Medicine Core encompasses multiple types of interventions, including medicines, neuromodulation, novel therapeutics and exploratory approaches, such as ketamine and psychedelics. It works closely with the VA Palo Alto Precision Neuromodulation Clinic and the National Clinical TMS program coordinated by the MIRECC at VA Palo Alto.
A major area of precision medicine focus is the integration of functional magnetic resonance imaging and electroencephalogram measurements to identify Veterans who respond to the neuromodulation therapy called Transcranial Magnetic Stimulation (TMS), and to validate why they respond. This focus involves a thriving collaboration between the Precision Medicine Core, the National Clinical TMS program, the Stanford Center for Precision Mental Health and Wellness, and VA and academic partners across the country, including at Providence VA/Brown University, White River Junction VA/Dartmouth University, Minneapolis VA/University of Minnesota.