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

by | Aug 11, 2013

Genetics and mental health

“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.

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