Psychiatric Perspectives on Prescription Digital Therapeutics

AJMC: What promise do prescription digital therapeutics (PDTs) hold for psychiatric treatment, especially of depression and schizophrenia?

MELNICK: Access to psychiatric care remains a significant challenge across the US, particularly in rural areas. In primary care, patients presenting with depression are often quickly started on selective serotonin reuptake inhibitors. Yet not all depression is rooted in neurochemical imbalance. For many patients, symptoms stem from life stressors—loss of a loved one, serious illness, or divorce—where medication may not be the most appropriate first step.

PDTs provide an accessible entry point to care, helping patients begin treatment without adverse effects and serving as a useful buffer before pharmacologic therapy. While not appropriate for severe cases, PDTs can be a valuable first-line option in primary care. In schizophrenia, PDTs show promise in addressing negative symptoms—such as withdrawal and lack of motivation—where medications are less effective. By supporting patients once stabilized, PDTs may ease transitions from inpatient settings back into the community, helping individuals move from nonfunctional to functional in daily life.

AJMC: How can PDTs complement existing in-person therapy or medication management for patients such as those whom you serve?

MELNICK: The role of PDTs is different for schizophrenia from what it is for depression. For schizophrenia, PDTs do not address positive symptoms such as hallucinations or delusions, which are linked to excess dopamine in the striatum. Instead, their promise lies in addressing negative symptoms, which may be related to dopamine depletion in the prefrontal cortex. Negative symptoms—social withdrawal, lack of motivation, functional decline—often resemble depression and are resistant to pharmacologic therapy. PDTs can provide training and skill-building interventions that help patients reengage with their environment, pursue employment, and become more functional members of society. In this way, they can complement antipsychotics by targeting areas where medication alone falls short.

For depression, PDTs may play an even greater role. A PDT has already received FDA approval for adjunctive use, and emerging evidence from Europe suggests potential benefit as a first-line approach. PDTs offer patients a nonpharmacologic option without adverse effects, which is especially valuable for those hesitant to start medication. They can also reduce barriers to traditional therapy, which is often expensive, time-intensive, and difficult to access for patients balancing work and personal obligations. By integrating PDTs early in treatment, clinicians can address both biologically driven and environmentally triggered depression, potentially achieving meaningful outcomes even before pharmacologic therapy is initiated.

AJMC: In which populations might PDTs for psychiatric disorders be most impactful?

MELNICK: A key advantage of PDTs is their availability 24 hours a day, 7 days a week. This makes them particularly valuable for shift workers, who often cannot access traditional therapy during standard hours. PDTs also hold promise for patients in rural areas, where psychiatric appointments may take several months to secure. By providing immediate, evidence-based support, PDTs can help bridge the access gap while patients await specialty care. They may also benefit Medicare, Medicaid, and commercially insured patients if reimbursement is secured, as weeks of PDT access can cost less than a single therapy session. Overall, the greatest impact is likely among underserved groups—shift workers, rural patients, and those with limited financial resources—where PDTs can expand access, reduce delays, and offer cost-effective care.

AJMC: What hesitation might psychiatrists have in prescribing PDTs for these disorders?

MELNICK: The primary hesitation is familiarity. Many practitioners are not yet accustomed to incorporating PDTs into psychiatric care. Greater education and training are needed—not only in medical and nursing schools, but also for experienced clinicians already in practice. Practitioners must learn when PDTs represent an appropriate therapeutic option and how to integrate them effectively into care pathways. With broader education and exposure, comfort levels will likely increase, particularly given that PDTs carry minimal risk and no significant adverse events. Ultimately, the barrier is less about safety and more about awareness and confidence—factors that can be addressed through structured education and real-world clinical experience.

AJMC: How might clinicians evaluate evidence for PDTs and use this to inform prescribing decisions?

MELNICK: Evaluating the evidence for PDTs requires rethinking where they fit in the treatment pathway. Too often, PDTs are considered only after patients have failed other interventions. The evidence, however, suggests they may be most effective when used earlier in the disease course. In depression, PDTs should not be viewed as an add-on after multiple medication trials. Instead, they can be introduced up front, with pharmacologic therapy added later if needed. This shift in perspective—placing PDTs first and layering medication when appropriate—may improve patient engagement and treatment outcomes. In schizophrenia, once positive symptoms are stabilized with medication, PDTs may play a key role in addressing negative symptoms and improving functional outcomes. Evidence should be assessed not only for symptom reduction but also for long-term impact on community reintegration and quality of life. Ultimately, the value of PDTs lies in their ability to complement existing treatments while expanding access, reducing delays, and improving functionality—benefits that should guide prescribing decisions and policy considerations.

AJMC: Abilify MyCite combines medication with a digital tracking system.¹ What is your impression of its clinical value?

MELNICK: We used Abilify MyCite briefly, but its marketing has been discontinued.² The pill’s embedded sensor and wearable patch tracked ingestion, though not reliably, and some patients with schizophrenia grew paranoid about the device. Clinically, the data provided little beyond basic adherence information, which limited its value. It was also tied solely to aripiprazole, limiting broader applicability.

Perhaps more importantly, the product had minimal insurance coverage despite its FDA approval, so patients were asked to pay a premium. Without payer reimbursement, even the most promising PDTs cannot be sustained. To realize long-term value in psychiatric care, payers should look beyond short-term expenses to the savings that PDTs may offer through better patient adherence and functioning.

AJMC: CT-155 has been studied as a digital approach for managing negative symptoms in schizophrenia. How might a clinician interpret findings about this therapeutic from the CONVOKE trial?³

MELNICK: The CONVOKE trial offers encouraging evidence that CT-155 can address negative symptoms of schizophrenia—an area where medications provide limited benefit—by reinforcing life skills and coping strategies critical for community reintegration. In clinical practice, especially within forensic psychiatric settings, negative symptoms such as social withdrawal and impaired communication often prevent patients from functioning independently, even after stabilization of positive symptoms. By teaching practical skills, from initiating conversations to managing everyday tasks, CT-155 has the potential to reduce barriers to social participation, free clinicians to focus on broader aspects of care, and ultimately support more successful transitions into society.

AJMC: Many PDTs use cognitive behavioral therapy (CBT) modules. How do you see these digital formats comparing with traditional CBT delivery?

MELNICK: Digital CBT modules are largely comparable to traditional delivery but offer distinct advantages in cost, convenience, and accessibility. Traditional CBT can cost $150 to $250 per hour, while a PDT may provide 6 weeks of access for roughly the same price, creating meaningful savings for patients and payers. Digital formats also allow patients to engage with therapy on their own time, at their own pace, and at an appropriate educational level, reducing barriers related to scheduling and adherence. Looking ahead, advances in artificial intelligence may further personalize these programs—adapting content to the individual rather than requiring the individual to adapt to the program—which could make digital CBT even more effective and scalable.

AJMC: How might psychiatrists identify good candidates for PDTs?

MELNICK:In depression, PDTs may be especially valuable early in the disease course, such as during first episodes. Too often, clinicians default to prescribing medication as a knee-jerk reaction, yet depression is rarely entirely biological. Environmental factors—stressors, losses, or life changes—often play a significant role. PDTs offer a way to address these nonbiological components early and effectively, complementing or even preceding pharmacologic therapy. By identifying patients at the onset of illness and targeting biological and environmental drivers, clinicians can improve outcomes while avoiding an overreliance on medication alone.

AJMC: What role might PDTs play in addressing provider shortages or reducing access gaps between appointments?

MELNICK: PDTs can help bridge the gap between primary care initiation and specialty follow-up, a period that often lasts months during which patients may start medication but receive little additional support. By engaging patients between visits, PDTs not only help them manage symptoms but can also generate data that alert clinicians when severity warrants expedited evaluation. In this way, PDTs provide a practical bridge between appointments, improving continuity of care, and reducing risks associated with long delays in access.

The challenge, however, is sustainability and access. Until PDTs become mainstream and insurance plans consistently cover them, cost remains a significant barrier. PDTs are often unaffordable for patients in rural areas, on Medicaid, or with limited financial resources. Without broader reimbursement, even effective tools risk being underutilized.

AJMC: Looking ahead, what PDT developments might better support psychiatric care?

MELNICK: Future PDTs will likely be enhanced by artificial intelligence, allowing programs to adapt dynamically to patients rather than relying on static modules, which could improve engagement and outcomes. These tools are especially valuable in addressing areas where medications fall short—such as the environmental contributors to depression and the negative symptoms of schizophrenia—and offer the advantage of minimal adverse effects. While randomized placebo-controlled trials are difficult in behavioral health, emerging data and forthcoming real-world evidence will be critical to demonstrate functional improvement and cost savings. To realize this potential, payer support is essential; without coverage, adoption will remain limited and innovation slowed, despite the promise of PDTs to expand access, improve care, and reduce long-term costs.

REFERENCES

1. Abilify MyCite. Prescribing information. Otsuka Pharmaceutical Co, Ltd. Updated January 2025. Accessed September 16, 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/207202s009lbl.pdf
2. Abilify MyCite. New drug application (NDA) 207202. FDA. Updated January 22, 2025. Accessed September 16, 2025. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=BasicSearch.process
3. Study of two digital therapeutics for the treatment of experiential negative symptoms of schizophrenia (CONVOKE). ClinicalTrials.gov. Updated July 23, 2025. Accessed July 25, 2025. https://clinicaltrials.gov/study/NCT05838625