Gene testing to guide antidepressant treatment: Is it timely? – Harvard Medical Letters


Depression is one of the most stressful situations in life. Fortunately, medications, psychotherapy, and lifestyle changes often succeed in treating depression and related problems, even if the symptoms are not completely eliminated & # 39; in. Sometimes people do not get enough help with treatment, or they have to try several medications before finding one that works well. In an age of exciting developments, including brain imaging and genetic testing, many doctors and potential patients are hoping that new technologies will provide answers. In fact, in selecting anti-depressants, several companies sell genetic testing to guide treatment. But do these tests work?

Genetics, genetic testing, and depression

Genetics determines some of the risks of depression and our treatment response. However, there is not one gene or a small number of genes that determine the majority of the population in general. And the few genes used in commercial trial directions do not now appear to be the primary genes that determine the risk or response. Some of the genes tested are related to metabolism. The driver genes can affect the blood levels of the drug, but generally can not predict clinical response. Among other things, including the & # 39; s, food, state hormone, intestinal, and other medications in time to take the very important decision & # 39; Making how maaweelinayo drugs and responses to treatment.

Most people with depression develop a careful assessment of all of these, proper antidepressants and dosing according to expert guidelines, as well as follow-up care to monitor treatment response and address any side effects. Currently, there is no scientific evidence that genetic testing is required or will contribute to any of that evaluation.

What do studies tell us?

Several studies focusing on patients with depression have reported the consequences of using a genetic testing laboratory to guide the choice of depression. Most of the studies were not completely hidden – that is, doctors and patients knew that a specific diagnosis was being given. Even according to that perspective, the use of genetic results did not show any significant evidence. Several studies have been partially ignored, but doctors and patients still know that some patients have a specific diagnosis. In these studies, too, trials have failed to demonstrate the value of their critical measures of effectiveness.

Remarkably, many patients do not respond well before entering a study because they receive inappropriate treatment. They did better when it was turned into a topical treatment. However, similar changes would have been made without guidance from the test if clinicians were simply observing good practices, rather than expensive and expensive genetic testing. And our ongoing review of new studies on these trials presents similar drawbacks and there is no further evidence of their preference for use.

What do experts say about using genetic tests to determine the treatment of depression?

Contrary to this background, experts with no financial interest in genetic testing have repeatedly advised that genetic testing should not be used in the treatment of depression (see here and here). The American Psychiatric Association convened a task force to review the evidence and agreed: trials should not be ordered.

Recently, the FDA has recommended that the tests have no proven value and should not be used. They then moved on for two more steps, saying that using tests can lead to inappropriate treatment choices that can hurt patients. In addition, the FDA sent a warning letter to one company and contacted others selling the tests, advising them that they could not legally make specific recommendations to doctors or patients based on the test results.

Why are genetic tests the way they are induced?

Genetic testing is appealing to both vulnerable patients and time-restricted physicians. It has been heavily marketed by both vendors: through news reports, websites, television, and magazines, and doctors' offices. There is little control over that marketing of facts, but the facts are clear from the evidence gathered by many experts and agencies. At present genetic tests have no proven value in the choice of anti-depressant therapy, and their use in the risk of inappropriate care. So, while genetic testing may be useful in some other cases, especially in cancer treatment, that success does not yet apply to the treatment of depression. Maybe this will replace more research, but more appropriate tests exist over the years.

If the genetic test is not effective, what is it?

At the moment, there are many good and effective actions that can be taken if treatment is not working properly. You and your doctor can

  • review your symptoms and symptoms
  • review the side effects of other medicines you take to see if this is part of the problem
  • be sure to take the medicine twice
  • consider other factors that may affect your response to treatment, such as alcohol, marijuana use, or other drugs
  • change the dosage or types of medications based on guidance advice, or seek expert advice.

When a medication modification is required, the treating physician must follow the instructions available (such as these) or assist you in consulting with a mental health professional who is knowledgeable about psychiatric medications. Psychological counseling is available at most hospitals and clinics; Some hospitals offer advice on the phone or on their website.

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