by John M. Grohol, Psy.D.
Prescribing medications has long been a trial-and-error approach for nearly any medication you could take. That’s been especially true in psychiatry, where there are dozens of medications that could be prescribed for common mental health concerns, such as anxiety, depression and attention deficit hyperactivity disorder (ADHD).
What if doctors had a better idea ahead of time which medications may work better for you than others, based upon your unique biology and biochemical makeup? They could then make prescribing decisions with a lot more knowledge, finding you a medication that would have a higher chance of working the first time.
This process is called pharmacogenetic testing — and it’s time is fast approaching.
Pharmacogenetic testing is the process of examining a person’s unique genetic structure to help determine what medication will metabolize best within that person’s system. The idea of personalized medicine like this has been around since the 1950s. But it hasn’t been until very recently that such genetic testing became inexpensive enough to make it within reach to millions.
Today, if you go into your doctor and say, “Hey doc, I’m depressed,” she’ll run through the list of symptoms of depression and determine if you actually meet the diagnostic criteria for depression. After some additional questioning and a discussion about your treatment plan, she may decide to prescribe you an antidepressant. She’ll typically choose that antidepressant from a list of more than a dozen different varieties, largely based upon her own professional experience in prescribing these different antidepressants.
Will It Work For Me?
Your symptoms are a part of the equation, but they won’t answer the most important question you should have when being prescribed an antidepressant — will it work for me?
Because research shows that after your first antidepressant prescription, less than 1 in 5 people will experience a positive effect from that medication. That means the vast majority of folks — 4 out of 5 — will experience no or little relief from their depressive symptoms.
That’s because medications today are largely prescribed randomly, with little regard to your biochemical and genetic makeup. This means that what works for someone else may very well not work for you. In short, it’s a pretty horribly random way to practice medicine.
Pharmacogenetic Testing to the Rescue
Pharmacogenetic testing can help us practice better medicine by having at least some idea about what medications may have potentially a great impact on your biochemistry.
There are at least two pharmacogenetic tests for ADHD. One is by a company called Harmonyx that just became available, and another is available from AssureRx. Some hospital systems, such as Duke, also can do in-house testing in their own labs. These kinds of tests usually cost less than $100 (paid out of your own pocket, typically), and will return a list of drugs, in order of their likely effectiveness for a given condition. AssureRx also offers a similar test for people with depression.
This area is still in its infancy, however. Pharmacogenetic testing is not a cure-all, and it won’t guarantee that even if you try the first medication at the top of your personal list, it will work and be effective for your ADHD or depression symptoms (other disorders will be forthcoming in future years).
But it’s an exciting development in the world of personalized medicine and improving the effectiveness of our existing treatments.