It’s no secret that depression is becoming one of the biggest epidemics in the United States and throughout the world. Many people suffer from mental illnesses, but depression is a condition that seems to affect everyone at some point in their lives. Unfortunately there is no pill that will cure depression, but there are various medications that help individuals manage their depressive symptoms.

Instead of making lifestyle changes such as eating an optimal diet for mental health or pursuing natural cures for depression, most people seek out the help of antidepressants. There is nothing wrong with taking an antidepressant medication if you are on your last leg and no lifestyle changes have helped. The problem with medications is that many people end up playing “antidepressant roulette” or hopping from one drug to another and getting unsatisfactory results.

GeneSight Psychotropic: Genetic Test Recommends Best Antidepressant Treatments

Fortunately, there is now a new strategy being implemented by some healthcare practitioners. It involves taking a look at a patient’s genetic profile to determine how they are likely to respond to certain antidepressant medications. It has long been known that many individual factors play a role in determining whether an antidepressant medication will work.

A new test called “GeneSight” developed by the company Assurex assesses an individual’s genetic profile to determine how a particular antidepressant may affect their metabolic processing as well as response to FDA-approved drugs utilized to treat depression. Therefore, not only would this new test aim to determine whether a certain medication may make you gain weight, but it would attempt to predict whether the drug would actually improve your depressive symptoms.

  • How it works: The GeneSight test functions by taking a swab from the inside of your cheek to obtain a sample of saliva. The saliva sample is then sent to the laboratory for analysis. The analysis involves looking at 8 specific genes that are commonly used to metabolize medications as well as those that are associated with serotonin.
  • Metabolic responses: Individuals who have quicker metabolic responses to medications may end up with inadequate amounts of the drug in their system. In other words, those who predictably will have faster metabolic reactions to an SSRI may end up metabolizing most of the drug and not getting a proper antidepressant effect. On the other end of the spectrum are those with slow metabolic responses, resulting in too much of the drug being used or feeling over-drugged.

The test then attempts to determine which drug will be optimal based on genes that regulate metabolic processes. In response to the testing Anthony Rothschild was quoted as saying, “If serotonin regulation and transport is normal, antidepressants that are selective serotonin reuptake inhibitors, or SSRIs, are probably not likely to be effective.”

GeneSight Trial: Suggesting antidepressants based on individual genetics

GeneSight is attempting to help psychiatrists make smarter decisions when prescribing antidepressants. They are essentially trying to save patients unnecessary trials and tribulations associated with medications that are unlikely to work. Many people end up trying medications for months at a time, and often get worse. The problem is that when a person continues to switch from one psychiatric drug to another, they often end up with an even greater chemical imbalance as a result of their medication “trials.”

This is because the new medication has created significant changes in physiological functioning before an individual switches to another drug. The GeneSight “test” is undergoing trial to determine whether it is likely to be accurate in predicting patient responses to antidepressants. Should such a test get approval, it would have potential to revolutionize the industry of psychiatry.

We already know that things like blood tests for depression are on the horizon as well as improved testing to establish the safety of antidepressants in humans (e.g. the Darwinian test) – this is all exciting for those involved in psychiatry.  However, we still haven’t managed to solve the modern day conundrum of determining efficacy and hierarchy of treatment options on a case-by-case basis.  This new testing would allow psychiatrists to develop a more individualized treatment protocol.

Potential Benefits of the GeneSight Test

The test holds potential for notable benefits, namely: predicting metabolic responses as well as whether a person is likely to experience symptomatic improvement on a particular medication.

  • Antidepressant prescriptions: If this test works well in predicting whether a certain antidepressant is more likely to help treat a person’s depression than another, a doctor won’t need to waste time with treatments that won’t work. This will lead to patients getting the antidepressant that is most likely to improve their particular mental illness.
  • Expansion: The company behind this test could theoretically expand their services to other genres of medications. For example, someone who is in need of a treatment for pain or high blood pressure may benefit from a particular medication or classification of medication over another. Individualized testing would be able to determine whether one medication is safer than another in regards to the person’s genes.
  • Individualized treatment: I recently wrote an article about how to improve psychiatric treatment outcomes by utilizing data tracking via brain scans. If this gene test works well enough, it will lead to people getting the individualized treatments that they need. In psychiatry, everyone with depression is essentially at the mercy of a random treatment selected by their doctor. In many cases the treatment selected will not end up working. This test will essentially weed through the many treatments that are unlikely to offer benefit.
    • Mechanism of action: Why does one SSRI work for one person, but a different SSRI works for another? This has a lot to do with the particular mechanism of action of the specific drug. Two people may find benefit from SSRI medications, but differing mechanisms of action determine how a person is likely to react to the drug. Both people may need a serotonin increase, but genetic profiles and physiology determine which particular SSRI works best.
    • Neurotransmitters: For some people, an SSRI medication may be the best treatment option, but for another individual an atypical antidepressant that affects norepinephrine and dopamine may be a superior option. This test will give psychiatrists some insight as to whether the person being treated would benefit from a serotonergic antidepressant or whether they should pursue another treatment such as with an NDRI.
  • Low risk: Even if the test doesn’t work for 100% of people, it is extremely low risk. All that needs to be collected is a saliva sample, and even if a medication is recommended that doesn’t end up working, it’s no worse than getting prescribed a drug at random. Therefore the gene test poses no risk to the patient.
  • Metabolic response: The test appears to test for genes that are involved in drug metabolism. They are then able to predict the speed by which your body metabolizes a particular antidepressant. You may metabolize one drug too fast, leading to poor efficacy of the medication, and another drug too slow, leading to abnormal side effects. The test searches for a drug that your body metabolizes at an optimal speed.
  • Predict side effects: In the future, they may be able to analyze your genes and determine what side effects you are more likely to experience based on your genetic profile. Some antidepressant side effects such as weight gain, sexual dysfunction, etc. may be predictable based on how you are genetically programmed to react to a specific drug.
  • Prevent adverse reactions: Each year there are thousands of adverse reactions to medications. Although not all of these adverse reactions stem from antidepressants, many do. This particular test may help psychiatrists determine which medications are likely to be problematic and cause adverse reactions.
  • Save time / stress: Most people on antidepressant medications end up trying many before they find a treatment that works. Instead of blindly throwing medications at a patient in hopes that something works, a doctor will have a better idea regarding what is likely to work. This will save the patient the time of undergoing a medicinal trial for a drug that is unlikely to help.

GeneSight Details: Using a “Traffic Light” System

Once results are assessed from the collected saliva swab, GeneSight is capable of categorizing over three dozen antidepressant and antipsychotic drugs. The results will then give a color-based rating based on an individual’s genetic profile. It uses a stoplight system to identify which drugs would be of benefit, which should be used with caution, and which should not be taken.

  • Green: These are medications that a patient is likely to benefit from and should be used as indicated. A person who’s test produces a green light next to a particular drug is likely to metabolize the medication optimally and improve in their depressive symptoms. Just like the stoplight, green means it’s okay to “Go.”
  • Yellow: These are medications that a patient may benefit from, but should be used with caution. As a stoplight reference, yellow means proceed with caution. This means that a patient could have problems with the drug, but may still get some benefit from the drug.
  • Red: These are medications that a person should probably not use. Those who test “red” for particular medications are more likely to have adverse metabolic responses to the drug. If a patient is prescribed a drug that shows up “red,” they likely need more extensive monitoring.

GeneSight Trials: Determining The Accuracy of the Test

The GeneSight testing is undergoing trials among psychiatrists to determine its accuracy. One psychiatrist ended up sharing how the trials are being conducted. Anthony Rothschild, a psychiatrist at UMass Medical School said, “For half the patients, I will be guided to strongly consider the green light medicines identified by the test; for the other half I will not use the test, just my own judgment, to prescribe for the first 12 weeks.”

He then stated, “After 12 weeks, whether the person is better or not, I will share with them the results of the test. If they’re better, fine. If they’re not better and I haven’t been using the test, I will use it. Or if I was using the test and they’re not better, I will consider another green light medicine for them to try.” The accuracy of the testing is currently unknown, but more data will likely surface as GeneSight trials progress.

Final thoughts on GeneSight testing…

GeneSight has potential to revolutionize psychiatric care with the development of this new test. Assuming that it is found effective, many patients will be able to avoid drugs that are likely to cause more harm than benefit. Additionally there are no inherent risks associated with this type of testing – it is non-invasive and won’t affect the quality of psychiatric care a patient receives.

These days psychiatrists simply pick an antidepressant and hope it works. Assuming GeneSight doesn’t work, it will have done no harm to the patient because psychiatrists will remain prescribing antidepressants at random. However, assuming it does actually work, patients will be prescribed medications that actually improve their symptoms and that they can tolerate.

I’m all for genetic testing to determine how a person is likely to react to psychiatric medications. It can only be hoped that GeneSight expands to genres of medications other than psychiatry as well. It has the potential to be used universally by all doctors and for all medications assuming different types of tests are eventually developed (e.g. test to determine which opioid will work the best).

So would you get the GeneSight test before taking an antidepressant? Feel free to share your thoughts in the comments section below. Assuming the test works, even a little bit, I feel like it’d be a no-brainer to get the testing and avoid medications that could potentially make you feel worse.  It should also be mentioned that creating a test to determine the degree of benefit a person would derive from specific dietary alterations, sleep changes, exercise, and/or various supplements would also be of significant help in improving various conditions such as major depression… these recommendations are likely currently too advanced for this initial protocol, but the future possibilities of genetic testing are seemingly endless.

  • Source: http://genesight.com/patients/genesight/psychotropic/