The wide realm of possibilities for using ChatGPT are expanding ever since the platform went public in the latter half of last year. The generative artificial intelligence (AI)-based platform most recently passed the United States Medical License Exam (USMLE) and improved zinc finger nucleases (ZFNs) for gene editing applications. This has spurred the use across various industries with the likes of Microsoft investing in openAI’s ChatGPT platform.

As Korea grapples with high suicide rates, this can prove to be a useful mental health tool. Korea has the highest suicide rate among Organization for Economic Co-operation and Development (OECD) nations at 26 out of every 100,000 people.

What exactly is ChatGPT?

Simply put, ChatGPT can be compared to Siri or Alexa, except that it functions in a text chat version instead of a voice conversation. However, it is trained by AI algorithms, so its performance is smarter than regular chatbots. It utilizes the principles of generative AI to produce a text output based on text input from the user, thus generating an almost human like-conversation.

Intrigued by the capabilities of this platform, many have started speculating on its use in healthcare. However, many began to question whether the AI platform could replace psychologists, similar to the comments made when AI started accurately analyzing medical images like radiologists.

Although it failed to be a replacement, Korea Biomedical Review (KBR) compared the responses from ChatGPT and Adaptable Human Solutions’ licensed clinical psychologist Dr. Jill Dunbar, evaluated the validity of ChatGPT’s responses and spoke to Ybrain, the manufacturer of an electroceutical device for depression, to evaluate ChatGPT’s potential as a mental health tool.

ChatGPT vs licensed psychologist

Q1. Lately, I’ve lost interest in doing the activities that I usually enjoyed doing like hiking and outdoor sports. Most of the time I just stay indoors and do not interact with my friends as much. It first started because I was busy studying but now I have more time and still do not want to engage in the activities I once enjoyed. I am just starting to get a bit worried because my personality seems to have changed. I’m usually a very outgoing person. Maybe I am worrying for nothing, but I spoke to a friend who knows me well and she thinks I might be suffering from depression. Do you think so too?

Psychologist: I'm sorry to hear that this has happened. It’s possible you can be experiencing depression, but I can’t be sure until I ask a few more questions. Roughly how long have you been feeling like this? Are you able to still enjoy things? Do you experience any pleasure in day-to-day activities or is that feeling of pleasure and joy missing? Was there an event, maybe something difficult, something quite frightening, or traumatic that happened around that time?

ChatGPT: You may be experiencing symptoms of depression, but only a mental health professional can diagnose it. If you are feeling persistently sad, lose interest in activities you once enjoyed, have changes in appetite or sleep patterns, and experience feelings of worthlessness or hopelessness, it's a good idea to seek help from a mental health professional. They can help determine the cause of your symptoms and suggest appropriate treatment options.

Q2: Sometimes I am also unable to concentrate on one activity as my mind races from one subject to the next. I live a pretty hectic life because of my job. I am constantly fidgeting and thinking of something else while doing one activity. It sometimes gets messy to organize my thoughts properly and makes it difficult to finish things. I was wondering if this could be a case of attention deficit hyperactivity disorder (ADHD).

Psychologist: Okay, I fully hear you and there are lots of different reasons why people can struggle with focus and feel distracted so it's something that I would first want to find out some more information if that’s okay. How long has this been happening? Is this something that you've struggled with all your life? Is this more recent? If it's been getting worse over time, what's it like? Is it only at work or in other situations as well? How would you compare yourself to other people, friends, and colleagues?

ADHD has recently become prevalent in social media, so people sometimes tend to self-diagnose themselves. It’s possible you might have ADHD but requires a thorough assessment before being diagnosed.

ChatGPT: It's possible that you may be experiencing symptoms of ADHD. However, only a mental health professional can diagnose ADHD. They would consider a range of factors, including a detailed history of your symptoms, and may also use standardized rating scales and other assessments to gather information. If you are concerned about your symptoms, it's a good idea to seek help from a mental health professional who can evaluate you and determine if you have ADHD or any other condition that may be contributing to your symptoms.

Q3. What can you advise me to do to solve these problems I am currently experiencing?

Psychologist: Based on what you said alone, I would not want to jump in with advice. I would need more information so that I can fully understand what your goals are because solving the problem looks different for everyone. But if it was depression and there's no trauma in the picture, I would probably suggest behavioural activation, a graded plan to increase activity and get you back to your enjoyed activities in a manageable way.

ChatGPT: If you are experiencing symptoms of depression and/or ADHD, the following steps can help:

1. Seek professional help: A mental health professional can diagnose your symptoms and develop a treatment plan that's right for you.

2. Practice self-care: Take care of your physical health by eating well, getting enough sleep, and engaging in physical activity. This can help improve your mood and overall well-being.

3. Manage stress: Find healthy ways to manage stress, such as exercise, meditation, or deep breathing.

4. Connect with others: Talking to friends and family, joining a support group, or seeking out therapy can provide a supportive environment where you can share your thoughts and feelings.

5. Consider medication: If you are diagnosed with depression or ADHD, medication may be prescribed to help manage your symptoms.

It's important to remember that everyone's experience is different, and what works for one person may not work for another. Finding the right treatment approach may take time, but with persistence and support, you can improve your mental health and well-being.

Q4. What are the chances I am suffering from both ADHD and depression? Are there studies where patients usually suffer from both of these symptoms?

Psychologist: It's very possible for someone to have both ADHD and depression. Sometimes having ADHD can increase your risk for depression especially if it's undiagnosed, it can increase your risk for depression on a social and relational level because you can see that you're struggling with things but cannot understand why which might frustrate you and make you think something is wrong but you don't have the answer and don't know how to deal with it. However, I can't comment now to say that you're at high risk of having both but there's a possibility and we would have to do a further examination.

ChatGPT: It is common for individuals to experience both ADHD and depression. Studies have shown that up to 50 percent of individuals with ADHD may also have some symptoms of depression. The co-occurrence of ADHD and depression can create a complex set of symptoms that can impact daily functioning, and it is important to receive a comprehensive evaluation and appropriate treatment for both conditions.

If you are concerned that you may be experiencing symptoms of both ADHD and depression, it's important to seek help from a mental health professional who can evaluate you and determine the best course of treatment. They may use a combination of medication, therapy, and lifestyle changes to help manage your symptoms and improve your overall well-being.

Q5. I do not want to be prescribed medicine as I do not want others to think I have problems and also medicine can sometimes have side effects. Are there things I can do to first change these habits?

Psychologist: Assuming you are diagnosed with ADHD and depression, taking medication is absolutely a personal choice and many people feel uncomfortable with medication so you’re not alone. Medication can certainly help but you're right, sometimes there are side effects so it's important to talk with a medical professional about the risks of medication and make an informed choice. You can certainly do things without medication, but sometimes an intervention works best alongside medication.

ChatGPT: Yes, there are non-medication strategies that can help manage symptoms of ADHD and depression. These strategies include:

1. Mindfulness and relaxation techniques: Practicing mindfulness, meditation, deep breathing, or progressive muscle relaxation can help calm the mind and reduce symptoms of anxiety and stress.

2. Exercise: Physical activity can help improve mood, increase energy levels, and reduce symptoms of depression and ADHD.

3. Sleep hygiene: Maintaining a consistent sleep schedule and creating a relaxing bedtime routine can help improve sleep quality and reduce symptoms of ADHD.

4. Cognitive-behavioral therapy: CBT can help individuals learn coping strategies and change negative thought patterns that contribute to depression and ADHD.

5. Skill-building and organization: Improving time-management skills, breaking tasks into smaller steps, and using a planner or to-do list can help individuals with ADHD better manage their time and responsibilities.

It's important to remember that everyone's experience is different, and what works for one person may not work for another. Finding the right treatment approach may take time, but with persistence and support, it's possible to improve your mental health and well-being without relying on medication. If you are concerned about your symptoms, it's a good idea to seek help from a mental health professional who can guide you in developing a treatment plan that meets your specific needs and preferences.

ChatGPT evaluated by psychologists

Dr. Dunbar expressed overall satisfaction that the responses were measured, balanced, and contained useful and practical information with continued emphasis that it is not a substitute for professional assessment and treatment.

“The information is appropriate in the context of seeking some basic advice and strategies, but I think ChatGPT or another similar technology can help individuals with mild presentations experiencing low-level mood disruption, or those simply seeking some practical information,” Dunbar explained.

She added that it can help increase people’s knowledge of mental health and suggest what they might need. Many struggle to find help so I support new and appropriate ways to increase mental health access, she said.

She quickly noted that the platform might be limited for individuals struggling with more complex symptoms but acknowledged it can encourage them to seek help from a qualified mental health professional.

Dr. Sung Yoonhee, a licensed psychologist from You&Me Psychological and Consultation Services shared similar thoughts about its usefulness but noted that the questions were phrased eloquently which most clients cannot do and just feel distressed, upset, depressed, and anxious.

“I noticed a lack of questions regarding risk but in fairness, the questions hinted towards a milder side of mood, but whenever someone mentions depression, I would definitely screen for risk to self,” Dr. Dunbar pointed out.

Highlighting some shortcomings of ChatGPT as a potential mental health tool, she commented, “People are unique and complex, and so too is mental health assessment. You can’t simply tick off symptoms.”

“I place a high level of importance on both verbal and non-verbal communication which includes demeanor, tone, emotional congruence, and the relationship I build with the person constitutes much of our shared understanding of an individual’s presenting difficulties,” she remarked. “These are simply impossible to assess using AI, and nor should they be.”

Dunbar stated that AI will not be able to replace the unique experience of working with a qualified and skilled psychologist to understand and improve your mental health. “Our imperfect nature is what makes us human, and being able to share your mental health journey with another imperfect human is all part of the process,” she shared.

Dr. Sung echoed similar sentiments. She then tested the program herself regarding failures for parenting struggles, marriage issues like an affair, and suicidal thoughts.

“I think my responses might be similar to ChatGPT and liked how it acknowledged its limitations giving information for suicide hotlines and not casting judgment for the affair,” she admitted. “The responses evoked empathy, validation, normalization and reframing of the problem which help the patient focus on growing and learning from mistakes rather than focusing on outcomes.”

Can ChatGPT be integrated into digital therapeutics (DTx) or electroceuticals?

ChatGPT in its current format has potential but appears to have equal limitations. However, that could change if some tweaks are incorporated into a dedicated mental health service.

KBR reached out to Ybrain which developed a depression treatment electroceutical called MINDD STIM that delivers non-invasive brain stimulation through transcranial direct current stimulation.

“Currently, MINDD STIM does not employ any generative AI technology but if used in our platform, it could help patients answer questions on electroceutical device usage, precautions, and side effects,” said Ybrain Vice President Kim Seong-Jin.

Kim added that it could collect information on an individual's daily life, predict mood and depression, and recommend the use of e-drugs according to the patient's mood.

When asked about other areas in mental health that could benefit, he replied, “Recently, AI has been actively used for product development in all stages of mental health prevention, diagnosis, treatment, and follow-up management. Using AI voice and conversation recognition technology can help predict and diagnose mental health conditions by integrating biomarkers such as EEG, heart rate variability, and more through wearable devices.”

In this regard, Kim announced that Ybrain is preparing a ChatGPT-type service based on users' mental health indicators called MINDD BLUE which will provide advanced and differentiated mental health management using medical data accumulated based on commercialized technologies.