Danny Smith to lead a new £4 million hub for metabolic psychiatry

2016 Lister Fellow Danny Smith will head up one of five new UKRI research hubs dedicated to severe mental illness (SMI). The Edinburgh hub, opening in April 2024, will explore the correlation between metabolic disorders and severe mental health conditions. It has been awarded £4 million by the Medical Research Council as part of their UKRI Mental Health Platform investment.

We caught up with Danny to discuss the new project and his ‘whole body’ perspective on mental health.

Congratulations on the new research centre. Can you describe in a nutshell what it will do?

We’ve always known that weight gain for people with SMI like bipolar disorder, schizophrenia and severe depression is a big issue, and it’s not entirely explained by medication side effects. Diabetes runs in families where there’s SMI but we don’t know how the connection works. People with SMI die 15 years younger, mostly because of cardiovascular and metabolic diseases. We hope to investigate, in detail and from lots of different angles, the mechanisms of the associations between metabolic problems and the risk of SMI. Whatever we discover will help us to refine and develop new metabolic treatments for mental illness, which is a very novel idea. Our aim is to bring the right people together to do this in detail, and to drive forward the whole area of metabolic psychiatry.

The centre is part of a wider UKRI initiative. Will the centres collaborate, or do they work as separate entities?

Five hubs are forming the Mental Health Platform. Our hub in Edinburgh, and others in Cambridge, Cardiff, London and Sheffield. Although there’s quite a lot of activity in each hub, the idea is that the hubs will integrate with each other so that the platform becomes a large-scale effort to address mental illness research.

Why is the platform focusing on severe mental illness?

Traditionally, SMI like schizophrenia and bipolar disorder don’t get as much attention as more common conditions like depression and anxiety. So, the MRC and UKRI were very keen that the focus was on understanding SMI, which has been relatively neglected.

You’re currently Chair of Psychiatry and Head of the Division of Psychiatry at the Centre for Clinical Brain Sciences at the University of Edinburgh. Will you continue in this role when the hub opens?

That’s a good question. For the time being, I’ll continue to be the Head of the Division of Psychiatry. But things are getting busy. I have been very fortunate with grants in the last year – I have two big Wellcome Trust grants on bipolar disorder that started in the last few months, so this finds me leading three programme grants for the next five years, all at the same time. But they are well funded, and I have a lot of support. The hub comes with funding for a project manager who will manage all the administrative load, for example.

What sparked your interest in metabolic psychiatry?

That’s an interesting story. About three years ago, someone called Iain Campbell came to see me. He had been researching non-medication options for treating his bipolar disorder, and he had been putting on weight. There are case reports of a ketogenic diet being helpful for bipolar disorder, so he decided to try it. His story is that within three days, his depression lifted as he went into ketosis and he’d been well for about a year, just on the diet with no medication. He wanted to research this and had been to see lots of different psychiatrists and other people who mostly thought this was a very left-field, fringe idea. But I thought there might be something in it. Iain put a video on YouTube of his experience, and it was picked up by some philanthropists in California called the Baszucki Group. They funded a pilot study of the ketogenic diet in bipolar disorder in Edinburgh with some interesting early results. There’s an excellent summary of the whole area published on NPR.org. We employed Iain, who has a PhD, to do that study, so it was extremely fortuitous. And it’s kind of grown arms and legs since then.

Do you have strong hypotheses about the correlation between metabolic and psychiatric conditions?
We have different work streams pursuing different areas. One looks at the genetic overlap between things like diabetes and severe mental illness. Those studies can look at the direction of causality – is it about metabolic disease causing mental illness? Or is it mental illness causing metabolic problems, and is there a vicious circle? Then there’s a health informatics workstream, which looks at large-scale data in the NHS and other places to try and answer some of those questions.

The workstream I’m more involved with is deep phenotyping, where we make repeated assessments of people’s metabolic status and mental health status, collecting lots of data over many time points. We can then look at whether there’s a pattern, such as their metabolic health becoming less good and triggering a relapse into mania, depression or psychosis. We can use machine learning approaches on that data to predict, on an individual patient basis, when they might be becoming unwell because of what’s going on in their metabolic state. Do any metabolic tests predict their mental relapse further down the line? So, it’s a combination of things. There are quite a lot of different aspects to it.

How will knowledge exchange led by people who have been through severe mental illness enhance your findings?

That’s a big part of the project. Iain Campbell, who I mentioned, is going to be employed to lead the lived experience input into the hub. There are various aspects to what people with lived experience will be helping us with, including the design of the assessments, data collection, and helping us look at the data. Also developing knowledge exchange activities and dissemination activities to get the information about what we discover out to the right people, to try and influence policy and that kind of thing. We have the LEAP (lived experience advisory panel), which is six people with a history of schizophrenia or bipolar disorder, who we’ll meet with regularly to keep them abreast of the activity of the hub and to get their input on what directions we should be going in. So yes, it’s a core part of the work.

Learn more about the UKRI Mental Health Platform