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...