HomeNews & PressWhich Anti-Depressant is Right for You? Your DNA Can Shed Some Light Which Anti-Depressant is Right for You? Your DNA Can Shed Some Light May 6, 2018News & Press Genomics is coming to psychiatry, with some doctors using a gene test to figure out the most effective anti-depressant for a patient. Paxil or Prozac, Zoloft or Lexapro? When treating a patient suffering from depression, Brent Forester considers which anti-depressant to prescribe—ideally, one that will ease psychic pain without side effects. It can be a tough call. Deciding “becomes somewhat of an art—and a lot of it is educated guesswork,” says Dr. Forester, chief of geriatric psychiatry at McLean Hospital in Belmont, Mass., an affiliate of Harvard Medical School. He worries that sometimes psychiatrists “may think we are better than we really are” at making these choices. That may change as Dr. Forester and others enlist genomics, a form of precision medicine and an intriguing new frontier for the elusive science of the human psyche. Other branches of medicine, such as oncology, have embraced gene-based testing to help determine which cancer patients need chemotherapy or surgery. But psychiatrists typically haven’t let genomics guide treatment decisions, Dr. Forester says. One test, called GeneSight, uses a genetic analysis of DNA samples from a cheek swab to help doctors figure out which drugs are likely to combat a patient’s depression. The test examines a dozen genes to determine how well the patient will metabolize certain drugs and how his or her brain will respond to them. The test predicts the effects of more than 50 anti-depressants and anti-psychotics. Based on a patient’s results, drugs are categorized as ones to be avoided, ones that have some drawbacks and ones that can be used “as directed.” Barbara Dellovade, a retired real estate broker in Acton, Mass., became depressed last year. Ms. Dellovade, who is 78 years old, was taking an anti-depressant, but “I wasn’t reacting well to it and it wasn’t helping me at all.” She consulted Ipsit Vahia, a geriatric psychiatrist at McLean Hospital and assistant professor at Harvard Medical School. Dr. Vahia told Ms. Dellovade about the genomics test, which retails for $1,500 and is covered by Medicare and some health plans. After receiving an analysis of Ms. Dellovade’s results, he switched her to a different anti-depressant and she began to respond in about six weeks, he says. Ms. Dellovade has been feeling better, she says, though “I am still not there.” Dr. Vahia has been using the gene test more with his older depressed patients but says clinical judgment remains paramount in prescribing. “The brain…is the most complex organ in the body,” he says. “This is a small step, but it is an important step. We are adding a degree of precision” to treating depression. McLean Hospital is one of 60 sites across the country that took part in a randomized trial of GeneSight. The results, which will be unveiled this week at the American Psychiatric Association meeting, showed that patients fared better when physicians chose a medication with the help of the test, rather than relying solely on their judgment. Among the 1,167 patients in the trial, half took the GeneSight test and half were prescribed drugs based purely on their doctors’ clinical assessments. Genetics helps you “marry” a patient with the appropriate medication, says Bryan Dechairo, executive vice president for clinical development at Myriad Genetics , which funded the trial. Assurex Health, a subsidiary of Myriad Genetics, developed the GeneSight test. The results were striking, according to doctors at several medical centers who participated in the trial. Patients were more likely to respond to anti-depressants when the gene test was used to determine which drug they should be on; researchers found a 30% greater response to the medicine when the test was applied. Every patient in the trial had been on at least one anti-depressant that failed to work, and some had been on several that failed. The study shows that genetic tests can lead to better prescribing decisions, says John Greden, the principal investigator in the trial. Dr. Greden, a psychiatrist and executive director of the University of Michigan’s Comprehensive Depression Center, says that until now, many doctors took the following approach: “My favorite anti-depressant is this one, so I will try it. Oh, that didn’t work, so I will try this one.” Unfortunately, he says, under that hit-or-miss method—albeit informed by training and experience—“fewer than 40% of patients achieve remission.” Every year, 16 million Americans suffer an episode of depression, he says, making pinpointed diagnoses essential. Some doctors took a while to come around to the GeneSight test. Charles DeBattista, a professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, says initially he was “somewhat skeptical.” “Prior to the study I used it very rarely,” says Dr. DeBattista, who specializes in patients with treatment-resistant depression. He has been using the test more on patients who “have had problems tolerating medicine in the past,” he says. “There is nothing magical about it; it is not a substitute for clinical judgment.” But it does inform him what drug to try on a patient with serious depression. His Stanford colleague Alan Schatzberg isn’t persuaded. The test “has some value,” says Dr. Schatzberg, a psychiatrist and a former president of the American Psychiatric Association. “It has some use but what it doesn’t do is tell you which specific drug to use.” He adds, “What the field really wants is a test that tells me which specific drug I should put my patient on.” That is precisely what Charles Conway, a professor of psychiatry at Washington University School of Medicine in St. Louis, likes about it. The test “provides recommendations,” Dr. Conway says. “It doesn’t say: ‘Give this drug only.’ It says: ‘You have a range of choices, which you will [make] based on your clinical judgment.’ ” Reprinted with permission from The Wall Street Journal. Patient Hints To Help You Have A Better New Year The holidays have ended, and a new year has begun—a time when many embrace a fresh start by setting New Year’s resolutions. This year, why not consider s... Read more Patient Movement as Medicine: Solutions for Anxiety Moving forward. It sounds like a nice idea, especially when you’re feeling stuck deep in the throes of an anxiety spiral. But it turns out that physically m... Read more Patient Weight-Loss Drugs and Mental Health: What You Need to Know New medications for weight loss seem to be flying off pharmacy shelves these days. But could they be linked to mental health conditions? Researchers are ... Read more Patient 3 million patients (and counting!) have now taken the GeneSight test! We’re thrilled to share that 3 million patients (and counting!) have now taken the GeneSight test! We're so grateful to the dedicated healthcare providers who... Read more Patient The Model Minority Myth and Mental Health The model minority myth stereotypes one cultural group, typically Asian Americans, as “intelligent, hard-working, and diligent and therefore more academically, ... Read more Healthcare Provider How Clinicians Can Help Support Their Patients Who Are Being Bullied How Clinicians Can Help Support Their Patients Who Are Being Bullied Acts of bullying can cause feelings of fear, loneliness and sadness, as well as depressi... Read more Patient Cyberbullying: Unique Challenges and Impacts ‘We lost our daughter to cyberbullying.’ McKenna Brown was an accomplished hockey player and scholar, known for her kindness, when she became the target of int... Read more Going Beyond Green, Yellow, Red on the GeneSight Report This blog summarizes key points discussed during the March 2024 GeneSight® Engage webinar Participants: Bernie Ranchero, MD, MS, MBA, medical direc... Read more Healthcare Provider Top 5 Reasons Patients Stop Their Mood Disorder Treatment Mood disorder treatment for depression can be challenging – and patients may become frustrated when treatments don’t work. In fact, when people with depres... Read more Patient The Impact of Gratitude on Depression and Anxiety “Say ‘Thank you,” a mother reminds her young kiddo. “T.G.I.F.!” we cheer at the end of a long week. We know it’s important to be thankful. But do we ... Read more Patient The Silent Thief: The 5 Things Depression Can Steal “Depression is a thief,” writes Abhinav Chaurasia, a marketing automation specialist in an essay on LinkedIn. “It steals your joy, your motivation, and your abi... Read more Patient How to Talk to Your Doctor about Anxiety Medication “When I was 27, I felt bad all the time,” writes Joanna Goddard on the popular Cup of Jo blog. She describes her initial experience with anxiety in detail. ... Read more Healthcare Provider Building Trust by Reducing Bias: The GeneSight Test as a Tool for Mental Health Equity This blog summarizes key points discussed during Myriad Mental Health’s July 2022 Webinar: Building Trust by Reducing Bias: The GeneSight Test as a Tool for Men... Read more Patient Anxiety and older adults: What to look for and how to help “It’s not how old you are. It’s how you are, old.” - French author Jules Renard Mental health is important at every age. But when people experience an a... Read more Patient Adult ADHD: Symptoms, treatment, where to start Many people may incorrectly think ADHD, or attention-deficit/hyperactivity disorder, only impacts children. After all, according to the Centers for Disease C... Read more Healthcare Provider It’s time to talk suicide: addressing stigma around a difficult topic Trigger Warning: This webinar discusses suicide. If you or someone you know has suicidal thoughts, please call the National Suicide Prevention Lifeline at 988. ... Read more Patient Stress Relief Methods for Family Caregivers Caring for a loved one can be a rewarding and meaningful experience. However, the day in and day out of taking care of someone who is unwell also can be challen... Read more Healthcare Provider Healthcare Professional Burnout and Links to Depression When Dr. Lorna Breen, an ER doc in Manhattan, died by suicide in April 2020, it opened up a public discussion about the burdens faced by healthcare professi... Read more Healthcare Provider Antidepressant Withdrawal or Depression Reoccurrence? What Healthcare Providers Should Know People who stop taking antidepressants may do so for many reasons: they may feel like it isn’t working, may feel unable to cope with side effects, or may not fe... Read more Learn more Learn more about GeneSight How to talk to your provider View our clinical studies
Patient Hints To Help You Have A Better New Year The holidays have ended, and a new year has begun—a time when many embrace a fresh start by setting New Year’s resolutions. This year, why not consider s... Read more
Patient Movement as Medicine: Solutions for Anxiety Moving forward. It sounds like a nice idea, especially when you’re feeling stuck deep in the throes of an anxiety spiral. But it turns out that physically m... Read more
Patient Weight-Loss Drugs and Mental Health: What You Need to Know New medications for weight loss seem to be flying off pharmacy shelves these days. But could they be linked to mental health conditions? Researchers are ... Read more
Patient 3 million patients (and counting!) have now taken the GeneSight test! We’re thrilled to share that 3 million patients (and counting!) have now taken the GeneSight test! We're so grateful to the dedicated healthcare providers who... Read more
Patient The Model Minority Myth and Mental Health The model minority myth stereotypes one cultural group, typically Asian Americans, as “intelligent, hard-working, and diligent and therefore more academically, ... Read more
Healthcare Provider How Clinicians Can Help Support Their Patients Who Are Being Bullied How Clinicians Can Help Support Their Patients Who Are Being Bullied Acts of bullying can cause feelings of fear, loneliness and sadness, as well as depressi... Read more
Patient Cyberbullying: Unique Challenges and Impacts ‘We lost our daughter to cyberbullying.’ McKenna Brown was an accomplished hockey player and scholar, known for her kindness, when she became the target of int... Read more
Going Beyond Green, Yellow, Red on the GeneSight Report This blog summarizes key points discussed during the March 2024 GeneSight® Engage webinar Participants: Bernie Ranchero, MD, MS, MBA, medical direc... Read more
Healthcare Provider Top 5 Reasons Patients Stop Their Mood Disorder Treatment Mood disorder treatment for depression can be challenging – and patients may become frustrated when treatments don’t work. In fact, when people with depres... Read more
Patient The Impact of Gratitude on Depression and Anxiety “Say ‘Thank you,” a mother reminds her young kiddo. “T.G.I.F.!” we cheer at the end of a long week. We know it’s important to be thankful. But do we ... Read more
Patient The Silent Thief: The 5 Things Depression Can Steal “Depression is a thief,” writes Abhinav Chaurasia, a marketing automation specialist in an essay on LinkedIn. “It steals your joy, your motivation, and your abi... Read more
Patient How to Talk to Your Doctor about Anxiety Medication “When I was 27, I felt bad all the time,” writes Joanna Goddard on the popular Cup of Jo blog. She describes her initial experience with anxiety in detail. ... Read more
Healthcare Provider Building Trust by Reducing Bias: The GeneSight Test as a Tool for Mental Health Equity This blog summarizes key points discussed during Myriad Mental Health’s July 2022 Webinar: Building Trust by Reducing Bias: The GeneSight Test as a Tool for Men... Read more
Patient Anxiety and older adults: What to look for and how to help “It’s not how old you are. It’s how you are, old.” - French author Jules Renard Mental health is important at every age. But when people experience an a... Read more
Patient Adult ADHD: Symptoms, treatment, where to start Many people may incorrectly think ADHD, or attention-deficit/hyperactivity disorder, only impacts children. After all, according to the Centers for Disease C... Read more
Healthcare Provider It’s time to talk suicide: addressing stigma around a difficult topic Trigger Warning: This webinar discusses suicide. If you or someone you know has suicidal thoughts, please call the National Suicide Prevention Lifeline at 988. ... Read more
Patient Stress Relief Methods for Family Caregivers Caring for a loved one can be a rewarding and meaningful experience. However, the day in and day out of taking care of someone who is unwell also can be challen... Read more
Healthcare Provider Healthcare Professional Burnout and Links to Depression When Dr. Lorna Breen, an ER doc in Manhattan, died by suicide in April 2020, it opened up a public discussion about the burdens faced by healthcare professi... Read more
Healthcare Provider Antidepressant Withdrawal or Depression Reoccurrence? What Healthcare Providers Should Know People who stop taking antidepressants may do so for many reasons: they may feel like it isn’t working, may feel unable to cope with side effects, or may not fe... Read more