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An AI-driven tool that tailors antidepressant treatment to individual patients could have a transformational impact for people with depression.
The PETRUSHKA tool supports clinicians and patients to choose an antidepressant tailored to each individual. It is the first time a mental health clinical prediction tool has been found effective.
It was developed by the University of Oxford and funded by an NIHR Research Professorship. The research was also supported by the NIHR Oxford Health Biomedical Research Centre and the NIHR Applied Research Collaboration Oxford and Thames Valley.
The tool uses AI to combine clinical and demographic information with patient preferences, including side effects. It takes 3 minutes to be administered and was tested in a randomised clinical trial across the UK, Brazil and Canada. It involved more than 500 adults with major depressive disorder and launched in 2024.
The findings have been published in the Journal of American Medical Association (JAMA). They show that people whose antidepressant was selected using PETRUSHKA were significantly more likely to:
• continue their treatment
• experience better mental health outcomes compared with usual care up to 6 months
In the trial, participants using PETRUSHKA were around 40% less likely to discontinue their antidepressant within the first 8 weeks of treatment. Fewer people stopped treatment because of adverse effects. By 24 weeks those in the PETRUSHKA group also reported greater improvements in depressive and anxiety symptoms.
NIHR Research Professor, Andrea Cipriani, Professor of Psychiatry at the University of Oxford, honorary consultant psychiatrist at Oxford Health NHS Foundation Trust and lead investigator of the study, said: “Mental health is lagging behind other fields of medicine and for too long, antidepressant treatment has relied on trial and error.
“PETRUSHKA shows that by combining the best available evidence with patients’ own preferences, we can personalise antidepressant treatment from the outset and help more people in the NHS stay on the medication that is right for them.”
Mike Lewis, NIHR scientific director for Innovation, said: “This study shows the real power of combining digital technology and personalised treatment.
"By harnessing data and embracing cutting-edge digital tools, we can tailor care more precisely to each patient - improving outcomes for individuals. Forward-thinking research such as this shows the impact of using innovative technologies to ensure patients across the UK receive smarter, more effective care.”
The tool was co-produced with people with lived experience of depression. It has been designed to be easy to use in everyday clinical settings, including primary care. Clinicians and patients use PETRUSHKA together during a consultation. This ensures that treatment decisions reflect both clinical evidence and individual priorities.
The research team say the tool could help reduce the personal, clinical and economic burden of depression. However, they add further research is needed to explore long-term outcomes and cost-effectiveness.
Henry Winchester, 45, a freelance writer from Bristol, was a participant of the study.
He said: “I was quite sceptical of antidepressants, I’d never really got on with them and had had severe side effects.
“PETRUSHKA found one that was much milder than what I had taken before. It’s been life changing in a way, having one tailored, and finding the right one for me. It could change the way antidepressants are prescribed and make it a lot easier for patients and better for GPs.”
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