Welcome to Chipur! If you’re struggling with a mood or anxiety disorder, you’ve come to a good place. Dig-in, okay? Thank you for stopping-by. Bill

Depressed? Which Antidepressant Is Right For You? Enter Genetics!

Depressed

“I‘m so tired of being depressed. But I’m even more weary of wondering which antidepressant is right for me – I’m on #4. Why are meds for the mind such a crap-shoot?”

How horrible it must be to feel so desperately depressed, and have zero luck with antidepressants. It’s the cruelest sort of tease, isn’t it? However, so it often goes with most any psychotropic. Ah, but perhaps the times – they are a changin’…

Personalized medicine is a medical model that supports medical decisions, practices, and/or products being tailored to the individual patient. Well, what better way to customize medical care than to work with the very foundation of who and what we are – genetics.

Genomind refers to itself as a personalized medicine company that strives “to bring science to psychiatry and to create new innovations that will help clinicians improve their patient’s lives.” (FYI: there are other personalized medicine companies offering similar services. Assurex Health is but one.)

The Genecept Assay

Genomind’s core product is the Genecept Assay – a tool for understanding genetic and biological markers that best inform responses to psychiatric treatments. Now, the assay doesn’t predict disease, and it isn’t a diagnostic tool. Its sole purpose is to assist licensed and prescribing clinicians in more quickly finding appropriate/effective treatments based upon a patient’s physiological and genetic profile.

With this science, treatment options can be more thoroughly addressed for situations such as depression, bipolarity, the anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and schizophrenia.

So how does the assay work its “magic?” It consists of a proprietary panel of biomarkers, an analytic report, and the availability of a consultation with a psychopharmacologist.

Crankin’ up the assay is simple. When the ordered test kit is received, the patient deposits (okay, spits) a small amount of saliva into a tube. The ordering clinician sends the sample to Genomind’s lab. Within three to five business days the DNA is analyzed, and a results report, with interpretation, is sent to the clinician. Cool thing is, a psychopharmacologist is available for consultation.

The assay examines key indicators such as gene variations, how the body metabolizes specific drugs, and how the drugs effect the body. Let’s take a detailed look at what Genomind takes into account…

  • Serotonin Transporter (SLC6A4): A protein that determines the amount of serotonin available between communicating neurons in the brain. An individual with a change in the DNA that encodes SLC6A4 may have a reduced ability to move serotonin, so s/he may be less likely to respond to SSRI antidepressants – and more likely to experience side effects.
  • Gated Calcium Channel: Controls the movement of calcium between cells. When cells get excited (a normal process), they talk to each other, using calcium as the messenger. Too much excitement caused by genetic changes that may increase calcium flow into parts of the brain can be a problem. This has been associated with multiple psychiatric disorders, including bipolarity and schizophrenia.
  • Ankyrin G: A protein that plays a key role in the function of sodium channels, which control the movement of sodium in and out of cells. The excitement factor and impact dynamics here are the same as calcium, above.
  • Serotonin Receptor (5HT2C): A molecule that plays an important role in signaling the body it’s had enough food. Atypical antipsychotics (Abilify, Seroquel, Risperdal, Zyprexa, Geodon, etc.), which block the activity of serotonin at this receptor, may also cause metabolic syndrome. Some individuals have a genetic variation that can lead to an increased risk for metabolic syndrome with the use of these medications.
  • Dopamine Receptor (DRD2): A molecule that receives signals from dopamine, a brain chemical that’s important for movement and perception. All antipsychotic drugs bind to this receptor and work by blocking the activity of dopamine in parts of the brain. Certain individuals have a genetic variation that can change the binding attraction of this receptor and lead to an icky response to antipsychotic medications.
  • Catechol Methyl Transferase (COMT): An enzyme that breaks down dopamine and norepinephrine in parts of the brain. In some individuals, COMT activity is higher than average, which can lead to lower levels of dopamine in the frontal lobe. This may have behavioral consequences, such as difficulty with memory and concentration, as well as experiencing symptoms of depression. Other individuals have higher levels of dopamine in their brain because the COMT enzyme doesn’t work as well.
  • Methylenetetrahydrofolate reductase (MTHFR): An enzyme that helps to convert folic acid to methylfolate, which the body uses to make brain chemicals such as serotonin, norepinephrine, and dopamine – and which ultimately helps to regulate DNA by turning certain genes on or off. Having changes in the DNA of the gene that makes MTHFR can lead to various behavior and cognitive problems.
  • CYP2D6, CYP2C19, CYP3A4: Enzymes found in the liver that work to break down a medication in order for the body to get rid of it. Changes in the genes coding for these enzymes can lead to faster or slower breakdown of medications. Faster breakdown can lead to lower levels of a drug in the body than would be expected. Slower breakdown can lead to higher levels.

Wow, huh? Now, as exciting as this science is, it’s young – and has its detractors. Still, most agree it’s time to get the technology rollin’ and work out the kinks along the way. Studies and refinements continue.

Incidentally, the Genecept Assay, and like services provided by other personalized medicine companies, is covered by many health insurance plans. ‘Course, if one has the cashola (I’m told between $500-$750) they’re all set. Genomind states it has a patient assistance plan, and I’m assuming other companies may, as well.

Oh, forgot to mention – a client faxed me his Genecept Assay report last week. Very thorough and telling – and his psychiatrist for sure used it in formulating his meds recommendations.

Hey! Are you depressed and struggling with which antidepressant is right for you? I believe this science could be super-helpful. Why not run it by your prescribing physician during your next visit?

More Chipur articles await your perusal. The biology and psychology of the mood and anxiety disorders? Meds, supplements, and devices? Plenty of meaningful information to be had. Please dig in.

  • If you, or someone you know, has participated in such testing, would you mind posting a comment? Thank You…
    Bill

  • Wanted to add this comment from Gilda, which she posted on the Chipur Facebook Fan Page https://www.facebook.com/pages/Chipur/128077027224478?ref=hl

    “AssureX or known as GeneSight is a very good place to have your physician or
    psychiatrist send a cheek sample to determine pharmacological metabolism
    of drugs. The P450 CYP2D6 enzyme is the most common to check.”

  • Leslie Ferris

    Bill, wow this is fascinating! I do not pretend in any way to fully understand everything you’ve written here, but here is what I love: we (collectively) are coming up with a way to prescribe meds that is better than throwing darts at the board in the dark – which is the way it has struck me from time to time in the past. AKA – let’s try one, and if that doesn’t work we’ll try something else. This is great stuff – I am going to share this one!

    • Hey, thanks, Leslie! Sure, I appreciate your visit and comment; but your sharing the science is even more meaningful. That means the info will likely benefit someone. And that’s what this is all about…
      Bill

  • Great information here Bill. I was not aware of the Genecept Assay, and it sounds like an amazing tool so that doctors can zero in on the medication that will be the best fit. Depression can be so debilitating and this sounds like an amazing tool that can help patients get exactly what they need. Thanks so much for sharing!

    • Happy to share, Cathy. There’s a lot of hope in testing such as this. And the cool thing is, the science can (should) only get better. Now it’s on to developing meds and other treatments that can take us to the next level of relief and healing. Thanks for visiting and commenting…
      Bill

  • Bill,

    You sir, are a mover and a shaker. FINALLY!! some straight talk about SOME science around the rampant prescription of these powerful, and/but sometimes very useful medications.

    BTW–can’t tell you how I love your mixing this fabulous scientific nomenclature with terms like, “icky responses.” Very high cool factor, Bill.

    When these medications are necessary–and as you well know, miraculously transformative for countless folks, your post adds to this good news in a most helpful way.

    Thank you for such researched, clear, concise and potentially life changing information.

    • Ah, you’re the man, Herby. Thank you for visiting and contibuting – always appreciated.

      Yeah, no doubt – introducing a heaping measure of science/reason into this meds madness is a very good thing. Your point is well taken: “…sometimes very useful.” Man, there’s such a fine line.

      You like the “icky,” huh? I’m glad, ’cause that’s comin’ straight off the top. Gotta’ rinse out a good bit of the starch in topics such as this.

      Come on back for a visit, k?

      Bill

  • This is FASCINATING and exactly the kind of new research I like to learn more about. Thank you so much for explaining it (though I’ll have to read it through a few more times:)) and bringing it to our attention. It’s thrilling to imagine what this will do!!

    • Thanks for your visit and comment, Lisa. You know, understand the scientific minutia really doesn’t much matter – heck, it’s genetics. Are you kidding me? What really does matter is good stuff is becoming available to lessen the “crap-shoot factor” when it comes to psychotropics. I have to add that in spite of neat developments such as this, we have a looooong way to go in terms of developing efficacious and safe drugs to manage emotional/mental disorders. However, as long as we’re stuck with what we have, we may as well do what we can to personalize their administration. Thanks again, Lisa…

      Bill

  • Doreen from Genomind was kind enought to post on the Chipur Fan Page https://www.facebook.com/pages/Chipur/128077027224478?ref=hl

    I’m posting her comment here, along with my reply…

    Hi Bill- thank you for this great article and for your support of the Genecept™ Assay. As you outlined, our saliva-based test is easy to administer – within 3-5 business days after the patient consents and provides the saliva sample to our lab, the clinician will receive a report that provides information on the patient’s genetic profile that uncovers genetic factors that influence response to treatment. This alternative approach to the trial and error process in psychiatry today has been found to be very helpful by reducing adverse side effect , drug-drug interactions and improving patient compliance. We have seen significant results in a study of 545 patients. The results are as follows from reporting clinicians: 76% elected to make changes to patient treatment, 87% indicated that the report influenced their treatment and 93% indicated the report increased their confidence in treatment decisions.

    There are clinicians in all 50 states using the Assay today helping thousands of patients nation-wide. We have a preferred provider network on our website and are happy to help patients educate their clinicians about the test. We are happy to answer any questions that you or the readers may have about our test by emailing info@genomind.com or calling 877-895-8658. To learn more about Genomind, log onto http://www.genomind.com. Thank you again for covering such an important topic.

    So glad you stopped by and posted, Doreen. It’s important to circulate such information. Hope you understand – I want to make sure Chipur readers know I’m not endorsing the assay or Genomind – rather, the science. K? However, if I thought your product was icky, it would never have made it to Chipur – or I’d have stated such. How’s that? Again, thank you for your visit and participation.

  • Trish

    My dd had this test done back in April. She had the MTHFR diagnosis and still fighting with the insurance company to pay for it. She is on Enlyte for this which is costing $175 every three months. There is only one other med -Deplin – costing about the same. The med is not working well and she is going off of it so if seems to be worthless testing. Is was $4,000 so it wasn’t inexpensive but her therapist told her it would be covered. Not sure we are there yet.

    • Hi Trish! Thank you for visiting Chipur, and commenting. Appreciate it.

      Wow! $4,000 for the testing. When writing the article, my research didn’t show anything close to that kind of fee. Perhaps a more sophisticated test? Still, the outcome wasn’t pleasing – and that sure is the bottom-line. As a therapist, I’ll guarantee I wouldn’t tell one of my clients a service was “covered” unless I called the insurance provider myself, confirmed it, and got it in writing. Ouch!

      No doubt, this is young science; however, I believe the future is very bright. Hoping things get better for all of us as research ensues. By the way, Trish, here’s a link to a site that focuses solely upon MTHFR mutations. Perhaps you’ll find it helpful http://mthfr.net/

      Again, thanks for stopping-by. Please do so again…

      Bill

  • Joey Bennett

    There are also other tests that will prove that the parts in the brain implicated in depression, ADD, mood disorders, etc. SPECT out of the Amen Clinics is one, but they are expensive. For much less money find a clinic that specializes in qEEG’s (newer version of EEG’s, that can show real time color plots of areas of the brain that are working to fast or too slow, and not communication with each other). Doctors have been using these for decades, but they never get the respect they are due from the psychiatric community.

    • Hi Joey! Appreciate your visit and contribution.
      I had a client who had a “work-up” through Amen Clinics. Yes, it was expensive – as were his med review appointments. Client faxed me the report and it was very interesting. In my opinion it’s still a young science, as is the genetic testing cited in this piece; however, the upside is just huge. And you’re right – it doesn’t get the respect it deserves in the doc community. Wonder what that’s about (cough, cough).
      Thanks for stopping-by, Joey. Come on back anytime…
      Bill

  • BarbCat

    This is very fascinating. I’m not a clinician, but I suffer greatly from bipolar depression and have been researching it years, so I do understand much of this science. My burning question is this: So, we get an analysis/genetic profile citing anomalies in these markers. What then? We’re still stuck with the same ol’, same ol’ meds which, in my understanding, do not address these anomalies at all. Are we still left with greater knowledge but nowhere to go with it? Hope this discussion is still alive now that we’re a year later in posting.

    • Hey, BarbCat. Glad you stopped-by and participated. Cool stuff, isn’t it? Ah, but you nailed the rub. So, great, we’ve spotted significant biomarkers. And as fascinating as it is, now what? In fact, it is very young science – and all it can do just now is suggest meds that may, or may not, be efficacious. ‘Course, that’s a step forward – and meaningful to many. But, yeah, so much more needs to happen on the R&D side of the fence. No doubt, it’s happening; however, it’s never quick enough, is it? Hey, as you were browsing, wonder if you saw this piece on ketamine – http://chipur.com/major-depressive-disorder-and-ketamine-fanning-the-flame-of-hope/ Seems as though something could develop in the not too distant future.

      Thanks again, BarbCat…

      Bill