Genetic Testing Could Help People Suffering From Depression



Genetic Testing May Benefit Individuals A recent study by the U.S. Department of Veterans Affairs suggests that pharmacogenomic testing could help doctors avoid prescribing prescription antidepressants that might have negative side effects. Pharmacogenomics investigates how genetics affect how the body responds to medications.

The study also found that patients who underwent genetic testing performed better than those receiving standard care. Over the course of the treatment's 24 weeks, the genetic testing group experienced a decrease in depression symptoms, with a peak effect at week 12. Each study subject experienced a severe depressive condition. The illness manifests as insomnia, an appetite loss, a gloomy mood, and suicidal thoughts.


Dr. David Oslin, director of the VA's VISN 4 Mental Illness, Research, Education, and Clinical Center, oversaw the study (MIRECC). He thinks the results will persuade medical professionals to consider using pharmacogenomic testing to inform treatment choices, with patients' consent.

The study was headed by Dr. David Oslin. Jonathan Hodges is to blame.

Oslin, a psychiatrist at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia, says, "From a VA policy viewpoint, I don't think that we would say the study is substantial enough that we advocate evaluating everyone." "The outcomes were not clear-cut, and in reality, only 15% to 20% of the patients had genes that would significantly interact with the recommended medication, which is a key finding of the study. Although the results were limited, I believe they will inspire healthcare professionals to test people and obtain this genetic information. If there are patient subgroups that would gain more from testing, it should be investigated in further studies.
the emphasis is on drug metabolization

Pharmacogenomic testing has been more well-known in recent years as a method of individualized medication selection, and it is frequently applied to the treatment of patients with conditions including cancer and heart disease. The medical community as a whole is of the opinion that the testing will also help treat people with severe depression disorder. However, there hasn't been much evidence to support superior clinical outcomes.

A variation in the genes that encode hepatic CYP450 enzymes, a drug metabolizing pathway in the liver, is the focus of the majority of pharmacogenomic testing at the moment. A commercial battery of genes centered on CYP450 was employed by Oslin and his associates. Eight genes were checked by the battery, and six of them looked for changes in liver enzymes.

According to Oslin, "the genes we investigated don't actually contribute to depression." They have to do with how a person's body metabolizes medications once they have been ingested. Some of these genes will cause the drugs to break down much more quickly than usual. Others will make the drugs metabolize considerably more slowly than usual, resulting in an overabundance of medication in your body.

The study's participants were beginning or changing their antidepressant medication treatment. Nearly 2,000 patients from 22 VA medical sites participated in the trial. They were randomly assigned to receive either standard therapy or pharmacogenomic testing, with the other half receiving the latter. Oslin and his colleagues wanted to know if genetic testing led to fewer drugs being prescribed to patients with known drug-gene interactions, and if this resulted in improved outcomes.

An relationship between a medication and a genetic variation that may have an impact on a patient's response to pharmacological therapy is known as a drug-gene interaction. Having that knowledge aids the practitioner in deciding on the right dosage for a particular patient.

The control group's patients underwent genetic testing, but their medical professionals were not shown the data. This indicated that those healthcare professionals chose medications for their patients without consulting pharmacogenomic tests.

According to Oslin, "it was actually the study's main focus." Does the pharmacogenetic test assist you in deciding which medication to employ on this particular patient?

The study discovered a noticeable trend in prescribing away from drugs with severe or mild drug-gene interactions. Comparatively to 26% of patients in the control group, 59% of patients in the genetic testing group received a medication that had no anticipated drug-gene interaction. The difference was described as "statistically significant and clinically important" by the researchers.

Oslin claims that when he began the study, he did not anticipate that the projected drug-gene interactions would have such a severe impact. The outcome "slightly surprised" him. He claims that there was a significant change in the avoidance of medications with a known drug-gene interaction.

The patients utilized a cheek swab to test their DNA.

Oslin said, "Some companies do employ a blood draw. "Neither option has a distinct edge over the other. It largely depends on how the business handles the sample. The most popular DNA sources are cheek swabs and blood samples. After that, the sample is used to examine a number of highly particular genes known to be connected to the metabolism of many different medicines, including antidepressants. However, in our investigation, we were solely concerned with antidepressants.

The patients were questioned by the researchers about their experiences with depression. The group who had the genetic testing fared better in terms of all three outcomes—depression remission, depression response, and symptom improvement. Over a period of 24 weeks, they were all statistically significant, with a peak effect at 12 weeks. At 24 weeks, there was no statistically significant difference in the groups' outcomes for depression.

Oslin says, "We were not powered to look specifically at 24 weeks." "That was not included in our main theory. Our main theory focused on an overall result. And in all three of the methods that we evaluated the results, we found a general effect. So, it's a case of the glass being either half full or half empty. The group that had the results of the pharmacogenetic test responded more quickly, which is another way to interpret the findings. Additionally, we did not test that. The group who had the genetic test, however, definitely exhibited a higher improvement in remission, response, and symptom improvement after 12 weeks in all three outcomes.

It's crucial to understand that the test does not indicate whether or not the patient will respond to the treatment, he continues. It provides information regarding the patient's drug metabolization. Therefore, it is not indicating to me that this is a beneficial medication for the patient. The patient doesn't metabolize this medication properly, therefore it's telling me not to prescribe it or maybe to change the dosage.

The researchers reported that the presence of PTSD in patients had a severe adverse effect on remission from depression in the supplemental material. In essence, antidepressants had no effect on PTSD sufferers. According to the literature, Oslin asserts, antidepressants don't work effectively for treating PTSD. He emphasizes that cognitive processing treatment and prolonged exposure, both of which are widely employed in the VA, are the primary psychotherapies for individuals with PTSD.

One of the unique ways we conducted this study, according to Oslin, was as a pragmatic study in front-line clinical settings. "Clinicians and their patients were exploited. Everyone who treated the patients had to confirm that they were receiving treatment for depression. However, they might have had comorbid conditions, and many of them did have concomitant PTSD, which had a negative impact on the success of their treatment.

The burden is minimal for all physicians who might want to provide pharmacogenomic testing in the future, according to Oslin. Receiving the test carries no risk for the patient.

Because the outcomes can be used for the duration of the patient's life, Oslin claims that the costs are actually extremely inexpensive. You're not referring to a test that is only valid for five minutes, then. And taking the exam carries virtually little risk. You're only having a blood test or a cheek swab. Cost, risk, and potential population benefits are all minimal. But generally, it's likely that this test will significantly help some people.

Reference: "Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder The PRIME Care Randomized Clinical Trial" by David W. Oslin, MD, Kevin G. Lynch, PhD, Mei-Chiung Shih, PhD, Erin P. Ingram, BA, Laura O. Wray, PhD, Sara R. Chapman, MS, OTR/L, Henry R. Kranzler Journal of the American Medical Association, July 12, 2022.                                                                                                                                                                                                       By VETERANS AFFAIRS RESEARCH COMMUNICATIONS


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