Those of you who suffer with depression and have tried to just grab an anti-depressant and go on your way…you know that this is NOT the way this works.
Depression is complicated and so is trying to treat it. TRIAL and ERROR is what it comes down to and the problem with that is that each attempt at a new drug may take weeks or months to figure out if it is working. You may see those commercials out there that say you will see results in as little as two weeks…don’t believe everything you hear. In most cases we don’t know if something is going to work for 3-4 months.
What is Genetic Testing?
Genetic testing for antidepressants is not as new as it may seem but I have only recently been introduced to the testing. My daughter HC struggles with depression and anxiety as well as a few other things and has had quite a time finding the perfect combination of drugs to help her depression.
This testing was recommended by her psychiatrist after a couple of years of trying to come up with the right cocktail unsuccessfully.
It was a simple process for sample collection. The nurse used a swab and collected a DNA sample from her cheek. The swab was then sent off to the lab and that is where the magic happens.
How Does Genetic Testing Work?
The lab looks at 12 different genes and test how they are processed by over 50 antidepressant drugs. I am a lab rat by trade and am very interested in how the actual process works…but I won’t bore you with the details involving enzymes and chemicals and receptors.
I will briefly explain the four types of antidepressants they test and how they work. The list kinda looks like a bowl of alphabet soup.
Just for fun here is the list with a few examples: SSRI, SNRI, TCA, and MAOI.
- SSRI Selective serotonin reuptake inhibitors (Prozac, Zoloft, Paxil, Celexa, Lexapro, Luvox)
- SNRI Serotonin and nonepinephrine reuptake inhibitors (Effexor, Cymbalta, Pristiq)
- TCA Tricyclic antidepressants (Elavil, Norpramin, Anafranil)
- MAOI Monoamine oxidase inhibitors (Marplan, Nardil)
They are split into categories based on how they react or inhibit certain chemicals in the brain. Many times you will hear someone say that someone has a “chemical imbalance” and although that is a much simplified way to explain the process it fits for this discussion.
The basic jest of the testing takes the results of the 12 genes actual activity with the drugs and categorizes all the antidepressants into three groups.
GREEN DRUGS – these are the medications that show no interactions with the person’s genes. These are the drugs that are least likely to cause any side effects.
YELLOW DRUGS – these drugs may still be used but do show some gene-drug interactions. These interactions would lead to potential side effects.
RED DRUGS – these drugs should not be prescribed. They are the medications that will lead to adverse reactions and little if any effective treatment.
Who Does Genetic Testing Help?
Humans vary genetically—not only in eye and hair color but in other ways, such as how we metabolize drugs. While the majority of people will metabolize drugs normally, a small percentage do not.
Besides my daughter…patients who are most likely to benefit include patients who have failed to respond to multiple medications (caused by ultra-rapid metabolism, causing drug levels to be too low), and patients who have had lots of side effects ( caused by slow metabolism, causing drug levels to be too high).
The results obtained by the doctors will provide information in the following three categories based on your genetic makeup:
- which medications may require dose adjustments
- which medications may be less likely to work for you
- which medications have increased risk of side effects
Here is an example of what a report will look like:
Where Can I Get Genetic Testing Done?
I can only vouch for the testing lab that we personally used which was GeneSight, from Myriad Genetics. We went through her psychiatrist who took care of all the insurance stuff and obtaining the kit. One nice thing about GeneSight is that 95% of their patients pay $330.00 or less. We paid less.
This company offers The GeneSight Promise: Insurance can be complicated, and we want you to feel comfortable knowing what you’ll owe. We promise that if your cost could be more than $330, we’ll call you before we process your test. That’s the GeneSight Promise.
I know this was a lot of technical stuff to absorb at once, but it comes down to a decision between you and your doctor.
If you or a loved one is having issues coming up with a treatment plan that works ask about being tested.
In HCs case we found that the GREEN Drugs List consisted of only two drugs and that she was classified as having treatment-resistant depression. This meant that in her case the doctors have to prescribe more than the recommended dose and use combinations of drugs to see results.
It has been a long road, but when we saw the RED Drugs List it made a lot more sense why she has struggled…every single drug in the DO NOT USE category was a drug we had already tried and had failed.
Don’t give up on treatment options…there is help out there.
Keep fighting the good fight