Real Personalized Medicine

The gene COMT has made its way onto some multigene panels for antidepressant therapy personalization.   Does it pull its weight, though?   What does your COMT test result tell you about which medicine might be right for your antidepressant treatment? COMT is the catechol-O-methyltransferase gene.   The protein that it makes helps break down certain neurotransmitters in the brain like dopamine, epinephrine, and norepinephrine.   Everyone inherits two copies of the COMT gene, and there are several forms which you can inherit from one or both of your parents.   There have been a number of studies looking at the relationship between a person’s inherited copies of COMT and development of psychiatric conditions.   Yet even with all this information that seemingly relates to antidepressant therapy, your COMT gene result may not provide much help for your doctor in choosing the best medicine to treat depression.   Let me explain why. Even if a ...

There are many genetic test panels available to help understand how you will respond to antidepressant therapy. Here is a strong word of caution, however. In the case of testing genes important for medicines for depression, measuring more genes is not better. Some genetic testing laboratories offer a panel of genes that can include up to 2 dozen genes. But does knowing your genotype for all of these genes increase the usefulness of the test? No, and here’s why. Remember that a pharmacogenetic test is only helpful if it can be interpreted by someone into a recommendation for dosing a medication. This is where evidence-based medicine is so important. Evidence for the usefulness of a pharmacogenetic test can be established through peer-reviewed literature in medical journals and demonstrated by clinical practice guidelines. Several societies have published guidelines about how to use pharmacogenetic test results to choose antidepressant therapy. They include CPIC, or the Clini...

As many as 50% of people with major depressive disorder don’t respond well to the first medication prescribed.  Antidepressant medicines can make you feel terrible if the wrong one is prescribed and feel great if the right one is chosen.  But choosing the right one can often take a lot of trial and error for a person experiencing depression.  You may be told it will be 2 weeks or more before a new medicine works.  You wait and wait.  The challenge can begin to feel insurmountable.  If it feels like there’s no easily measurable test for these medicines, that’s wrong.  Here’s why.  A pharmacogenetic test could provide some key information.   Pharmacogenetic testing measures and reports which copies you have of genes that affect the medicines you take. Your genes decide how your body responds to a medicine or how your body breaks down a medicine. For example, knowing about your genes can tell your doctor: Which medicine is likely to work...

When you have questions about a gene test result, many people turn to the internet for answers. You may find a flood of information. Some information you find online is accurate; some is not. A lot of information online is placed there by commercial labs who are marketing to you or to your doctor. By their nature, these labs may have a bias toward how test results are interpreted. Some online “information” is really an opinion. This blog is set up to be a bias-free space. Evidence-based practice is any practice that relies on published scientific evidence for decision-making. Evidence-based personalized medicine means looking at scientific evidence to interpret an individual person’s test results. We know that one-sized medicine doesn’t always fit. We now know a lot about how your genetics influences how your body breaks down medicines or how some medicines may act in your body. But honestly there is still a lot we don’t know, too! The goal of evidence-based personalized m...