In this episode of Mind the Methods (the ISCTM podcast), Dr. Mark Opler speaks with Dr. Elizabeth Ballard, Associate Scientist at the NIMH Intramural Research Program and the 2025 recipient of the ISCTM Lewis Alan Opler Prize, about the evolving science of suicidal ideation and behavior. Dr. Elizabeth Ballard explains why many commonly used tools were built for risk documentation and legal protection, not for detecting treatment-related changes in clinical trials, and how repurposing them can obscure true signals, particularly for rapidly acting interventions. Drawing on trial examples, Dr. Elizabeth Ballard highlights how different measures (full scales vs. single items/subscales) can yield different conclusions about treatment effects, underscoring that measurement choice can be the difference between “it didn’t work” and “we didn’t measure it correctly.” The conversation also addresses the field’s “catch-22”: trials often exclude participants with suicidal ideation/behavior, limiting what we can learn about how treatments affect people with lived experience. Dr. Ballard discusses practical steps to safely include higher-risk participants, IRB and DSMB education, clear monitoring and response pathways, adverse event planning, and shared resources across research networks. Looking forward, Dr. Elizabeth Ballard describes a “both/and” future that blends clinician interviews with self-report, ecological momentary assessment, and emerging objective/implicit measures, arguing that suicide risk is dynamic and variable, and our tools must evolve to capture that reality.

In Part 2, Amir Kalali, MD, Independent Consultant, continues the discussion with Luca Pani, MD, focusing on how AI could fundamentally transform CNS drug development by enabling deeper biological insight, patient enrichment, and real-world outcome assessment, while emphasizing the cultural resistance, regulatory transparency, ethical trust, and leadership readiness required for responsible adoption.

In Part 1, Gary Sachs, MD, Clinical Vice President at Signant Health, moderates a discussion with Luca Pani, MD, President of ISCTM and Chief Regulatory and Innovation Officer at NetraMark. The conversation examines how AI can be used to support drug development, clinical trial design, and data interpretation, alongside key regulatory, ethical, and scientific considerations.