Shaping the future of psychiatry with precision medicine

In a comprehensive Genomic Press Interview published today in Genomic Psychiatry, Dr. Mirko Manchia opens up about his transformative journey from a small Sardinian city to becoming a leading voice in psychiatric pharmacogenomics, revealing how personal family experiences with mental illness sparked a lifelong quest to understand why psychiatric medications work brilliantly for some patients while failing others.

The Associate Professor of Psychiatry at the University of Cagliari has spent decades unraveling one of psychiatry's most perplexing puzzles: why does lithium, psychiatry's oldest mood stabilizer, transform some bipolar patients' lives while leaving others searching for alternatives?

From personal experience to scientific breakthrough

Growing up in Sassari with no medical background in his family, Dr. Manchia's path into neuroscience began with what he describes as "profound familial events" during adolescence that connected him deeply with mental health. This personal connection would later fuel groundbreaking research that culminated in a landmark publication in The Lancet, identifying genome-wide significant associations for lithium response in bipolar patients.

"I saw patients who had severe illness trajectories and who had remained well after several years of treatment with mood stabilizers, especially lithium, while others experienced continuous recurrences with dire consequences on their lives," Dr. Manchia reflects in the interview. This observation became the cornerstone of his research philosophy.

Building international collaborations

As a co-investigator and founding member of the International Consortium on Lithium Genetics (ConLiGen), Dr. Manchia has helped coordinate one of psychiatry's most ambitious pharmacogenetic efforts. His meticulous phenotypic analysis of patient samples has been instrumental in identifying genetic markers that could predict treatment response before patients endure months of trial-and-error medication adjustments.

The impact extends far beyond lithium. With 230 peer-reviewed publications spanning molecular genetics and clinical psychiatry, Dr. Manchia has established himself as a bridge between laboratory discoveries and real-world patient care. His dual appointments at Cagliari and Dalhousie University in Canada reflect this international reach.

Precision medicine takes center stage

Currently serving as chair of the European College of Neuropsychopharmacology (ECNP) Bipolar Disorders Network, Dr. Manchia envisions a future where genetic testing becomes routine in psychiatric care. "We are at a point in psychiatric genetics where clinical utility is emerging," he states. His current focus includes developing healthcare pathways that integrate pharmacogenetic testing for treatment-resistant depression and implementing AI-based predictive tools.

What makes this vision particularly compelling is its practical application. Rather than pursuing abstract genetic associations, Dr. Manchia's work centers on questions every psychiatrist faces: Which patient will respond to this medication? How can we minimize the devastating trial-and-error period that often characterizes psychiatric treatment? Can we predict and prevent treatment resistance before it develops?

Addressing research disparities

The interview also highlights a critical challenge facing psychiatric research: chronic underfunding compared to other medical specialties. Dr. Manchia advocates for increased investment, noting that oncology's transformation followed massive research funding. "This could also be achieved in psychiatry, but we need to act in a harmonized way, involving all stakeholders, particularly patient and family associations," he emphasizes.

His approach to this challenge reflects the same patient-centered philosophy that drives his research. By involving patient organizations in research development and dissemination, Dr. Manchia believes the field can build the public support necessary for sustained funding increases.

Looking ahead: Digital integration and beyond

The interview reveals Dr. Manchia's vision for psychiatry's future, where digital monitoring, psychometric assessments, genomics, and brain imaging converge into comprehensive predictive models. Within 20 years, he predicts, these integrated approaches will fundamentally transform how mental health is managed and delivered.

Yet despite these technological advances, Dr. Manchia's motivations remain deeply human. When asked about his greatest passion beyond science, he mentions Roman history, classical music, and playing guitar – reminders that even cutting-edge researchers need balance and perspective.

Dr. Mirko Manchia's Genomic Press interview is part of a larger series called Innovators & Ideas that highlights the people behind today's most influential scientific breakthroughs. Each interview in the series offers a blend of cutting-edge research and personal reflections, providing readers with a comprehensive view of the scientists shaping the future. By combining a focus on professional achievements with personal insights, this interview style invites a richer narrative that both engages and educates readers. This format provides an ideal starting point for profiles that explore the scientist's impact on the field, while also touching on broader human themes. More information on the research leaders and rising stars featured in our Innovators & Ideas – Genomic Press Interview series can be found in our publications website: https://genomicpress.kglmeridian.com/.