Author: Ilana Marcus / Source: Washington Post
Grit alone got Linda Greene through her husband’s muscular dystrophy, her daughter’s traumatic brain injury, and her own mysterious illness that lasted for three years and left her vomiting daily before doctors identified the cause.
But eventually, after too many days sitting at her desk at work crying, she went to see her doctor for help.He prescribed an antidepressant and referred her to a psychiatrist. When the first medication didn’t help, the psychiatrist tried another — and another and another — hoping to find one that made her feel better. Instead, Greene felt like a zombie and sometimes she hallucinated and couldn’t sleep. In the worst moment, she found herself contemplating suicide.
“It was horrible,” she said. She never had suicidal thoughts before and was terrified. She went back her primary care doctor.
In the past, when Jeremy Bruce, Greene’s physician in Cincinnati, treated patients for depression, he followed the same steps for almost everyone: start the patient on one antidepressant and switch to another until something helped. Sometimes, before they found the right treatment, the patient would leave his practice to find a new doctor.
“They would usually be very angry,” Bruce said.
But about three years ago, Bruce tried a new approach.
For patients who weren’t responding well after trying one or two different antidepressants, he started sending samples of their DNA to a company that says it can use an individual’s genetics to match them with the antidepressants most likely to work for them. Bruce said the test’s recommendations seemed to help some of his patients, so now he offers the test to any patient with depression — before they even try the first antidepressant.
“Psychiatric medicines make people feel horrible if you choose the wrong one,” Bruce said. “And they feel great if you choose the right one.”
In Greene’s case, the genetic report she got back put all the medications she had tried on a list of drugs unlikely to work for her, so she stopped taking them. She went to a different psychiatrist, who used the test results to prescribe something deemed better for her genetic makeup and says the meds seem to be working.
Doctors increasingly use information about genes to evaluate potential risk for some diseases, such as BRCA genes that are linked to breast cancer, and to determine the best drug treatment for diseases, including acute leukemia and HIV. But using pharmacogenetics to help treat depression remains controversial.
Doctors such as Bruce say they have seen promising patient results, but others say there is not enough solid evidence to show that pharmacogenetics can work for the complexities of mental health treatment. Some lab tests have shown relationships between genes and the way a drug physically affects the body, but studies on whether using that information leads to better results for patients have been inconclusive.
Bruce Cohen, director of the Program for Neuropsychiatric Research at McLean Hospital, a Massachusetts psychiatric treatment and research center affiliated with Harvard Medical School, says studies so far haven’t shown that genetic testing to choose antidepressants leads to collectively better outcomes for patients.
“The differences are very small, and there’s no reason to think you couldn’t have done better by just following standard protocols, which are free,” he said. According to the National Institutes of Health, genetic testing can cost anywhere from $100 to more than $2,000.
Cohen says most of the genetic tests check for variations in genes related to metabolism, affecting how a person’s body processes a drug. Faster metabolism can lead to lower drug levels in the body, while slower metabolism can cause higher levels. But such factors as age, diet and other substances in the body also have a major influence on the processing of the drug.
“Metabolism is only a part of drug response, and even it is more determined by…
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