“After years of trying everything, I finally decided to go on medication for my depression and anxiety. The first one I tried made me feel like I was climbing the walls. The second one did nothing for me at all. What medication do you think is best? I am starting to feel like nothing can help me.” Irene L.
We get emails like this all the time—like, every single day. Which makes sense because, like Irene, 50 percent of depression sufferers do not find the right medication (one that helps and has tolerable side effects) on the first try. In fact, many Anxiety Sisters we speak with are on their third or even fourth drug, which still isn’t working for them. What makes the situation even more difficult is that commonly prescribed medications like SSRIs/SNRIs (e.g., Prozac, Zoloft, Paxil, Cymbalta, Pristiq, Effexor, etc.) take a month to 8 weeks (or more) to get into our systems, which means there is no immediate relief—only side effects and symptoms—for quite a long time. There is already so much suffering with a brain illness like depression; when medication fails to improve the situation, we completely understand why Irene and so many other Depression Sisters begin to despair.
Since everyone processes and responds to medication differently, there is no way for us to advise anyone on the “best” medication (also, we’re not doctors!). However, a relatively new field called pharmacogenomics—the study of how genes affect an individual’s response to drugs—is giving us some hope. The idea behind pharmacogenomics is that medication prescriptions can be personalized, based on the patient’s genetic profile.
One company, Myriad Genetics (we should disclose here that Myriad is one of our sponsors, but we chose them because the work they do is so beneficial to so many folks), has developed a genetic test called GeneSight® as part of its quest to personalize medicine and improve the quality of life for depression sufferers worldwide. Using a simple cheek swab (no needles for our Phobic Sisters!), scientists can analyze someone’s DNA in order to determine which medications are unlikely to work well (low response, high side effects) for that person. It’s a bit like removing hay from the haystack in order to find the needle.
For our Science Sisters, here’s a bit more info:
We all have gene variants that determine whether our livers are fast, slow, or normal processors of medicines. About 70 percent of us have livers that digest and filter normally. The other 30 percent of us have livers that work faster or slower. Those with particularly speedy livers metabolize medication more quickly thus requiring higher doses of certain medications to find relief. These fast processing livers also are the reason that certain medications stop working, even after a promising start. Those with slower livers metabolize drugs at a slower pace and thus may feel more/stronger side effects from certain medications. These folks may benefit from lower doses.
The GeneSight® test provides a report that lists three categories of medications: (1) the GREEN column lists drugs likely to metabolize normally based on genetics, (2) the YELLOW column lists drugs that may or may not metabolize well—therefore, they should be used with caution and (3) the RED column which lists drugs not likely to metabolize well based on the patient’s genetic profile.
Clearly, those of us who fall into the 30 percent of folks whose livers are faster or slower than average will benefit more from this test than those whose livers are “normal” processors. We would argue that knowing how your liver works is good information for anyone who takes medication although, at this time, GeneSight® is indicated only for people diagnosed with depression who have already tried at least one medication that was not helpful or tolerable.
Data from a recent study of the GeneSight® test is very promising:
- Patients whose clinicians used the GeneSight® Psychotropic test to guide their treatment experienced a 50% improvement in remission rates compared with patients whose clinicians did not use pharmacogenomics
- Patients whose clinicians used the GeneSight® Psychotropic test to guide their treatment experienced a 30% increase in response rates at week 8 compared with patients whose clinicians did not use pharmacogenomics
- Symptom relief was achieved more quickly in the GeneSight® group
And it’s covered by Medicare and other private health plans (it’s a pretty affordable test, even without insurance coverage)!
While we love research-based data, we also are huge believers in anecdotal evidence. Carmala Walgren, Anxiety Sister and mental health advocate extraordinaire, has suffered from depression for almost 50 years. For years, Carmala took medication which, although somewhat helpful in relieving depression symptoms, made her incredibly tired—sometimes, too exhausted to do the things she wanted to do. When she finally took the GeneSight® test, she discovered that her medication was on her red list! In other words, her liver was not processing the medication optimally, which was causing her to be exhausted all the time. Now, Carmala takes a medication from her green list and is feeling better today than she has in years! (To hear Carmala’s story, listen to our latest podcast.)
For more information on GeneSight®, click here.
Have any of you tried pharmacogenomics? Please let us know…