July 07, 2008

Report: Anti-Depressants Don't Work In 40 Percent Of People Due To Four Genes

File this under "well now they tell us": Mayo Clinic psychiatrists announced last week at a conference in Britain that 40 percent of people who take an anti-depressant cannot respond to the medication owing to a genetic "abnormality."

"They [Mayo docs] have identified four genes that interfere with the efficacy of antidepressant medication, including two that prevent metabolising the drug (CYP2D6 and CYP2C19) and two more that prevent the brain from absorbing or transporting serotonin.

"Professor David Mrazek, chair of the Department of Psychiatry at the Mayo Clinic College of Medicine, said: 'One in 10 of our patients have abnormal CYP2D6, the gene most commonly implicated in treatment-resistant depression. This means that they are poor at metabolising some common anti-depressant medication including Prozac and Seroxat [Paxil's UK name]. As a result, they may get adverse effects including nausea, headache, vomiting and sexual problems, from a regular or even low dose of the drug.'"

Oh, so this is why Prozac, Paxil, Zoloft, Wellbutrin, Lexapro and Luvox screwed me up. Kinda nice to know this 18 years after I took my first anti-depressant. Who do I see for a refund?

Smartassery aside, if the Mayo docs are correct that 40 percent of patients cannot respond to anti-depressants, then that's a real kick in the pants to pharma's sales and perhaps merits some kind of FDA advisory, because the implications of their findings are that on the order of 40 percent of people taking anti-depressants probably shouldn't be. What's more, it also brings to the fore the need for people to have appropriate genetic testing before being put on an anti-depressant or to be tested if they are having poor responses to these drugs. The trouble is that a test for just one gene can run about $300, so it's not clear who'd pay to have all four genes tested--the patient? An insurance company? Drug makers themselves?

It'll be interesting to see if further research replicates these findings and how the mental health industry sorts out making appropriate gene tests available to patients.

Posted by Philip Dawdy at July 7, 2008 12:05 AM
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Comments

I beg your pardon?:o)
gene tests are reliable, acurate, exact, explains everything and people with a "positive" result will be put on Zyprexa?
I believe it's a joke. de Mayo is just making us laugh a little bit.
Visiting their sites is very funny and I recommend it for those who needs to laugh.

Posted by: Ana at July 6, 2008 11:30 PM

"those who need I meant"... sorry!

Posted by: Ana at July 6, 2008 11:32 PM

Hurray - it's scientifically proven: it really is the patient's fault if (s)he gets fucked up by antidepressants. What a crock of shit.

And to follow your train of thought, Philip: I wasn't even given a DRS questionnaire to fill out, so the likelihood of patients being gene tested is on the same scale of probability as finding rocking-horse shit, I imagine. Anyway, given what NICE has to say (ie, that SSRIs only work in the severely depressed), are we to assume that only the severely depressed have the requisite four genes? I repeat: what a crock of shit!

Matt

Posted by: Matthew Holford at July 7, 2008 02:32 AM

Most people who are slow metabolizers (CYP2D6)cannot tolerate ANY med that goes through the liver that way--my daughter, mom and myself cannot tolerate anti depressants or anything that effects CYP2D6 pathways.

There are blood tests that can confirm this, and as a result one of my daughter's has "allergy to SSRI's" in her medical chart and it goes on her wrist if she is in a medical hospital; which as one can imagine is a good thing, if it's a psychiatric hospital!

She had adverse reactions to Luvox,Zoloft, Prozac etc. I did extensive research on this topic years ago. If one reads basic fine print of how the mechanism of action works in a drug, it's an easy way to say "no thanks doc, that drug won't work."

Posted by: Stephany at July 7, 2008 03:56 AM

PS--the blood test should be ran before a patient is placed on any medication; it's easier than playing the "what cocktail works" game.

Some insurance companies pay for it.

Posted by: Stephany at July 7, 2008 03:58 AM

The pharmaceutical companies have long been aware of CYP2D6 and intolerability to SSRI drugs, but because of the expense of individualizing each patient and running tests etc, they decided not to enlighten the general public about this..

Yet more tomfoolery from an industry which regards profit as the prime motive , patients health has never come into the equation..

I would like to see more main stream coverage of this issue though...


Posted by: truthman30 at July 7, 2008 08:22 AM

Well where does this leave someone like myself who believes that antidepressants don't work in 100 percent of the people who take them at least if you give them enough time to do their dirty work? These gene variations are just throwing the public a curve ball as far as I'm concerned. Yeah maybe the gene variations do make a slight difference in how you react and what dose does what to you over what period of time but the bottom line is the drugs are bad news for anyone and everyone. Remember -- they're neurotoxic according to Peter Breggin, Grace Jackson, Joseph Glenmullen and many others who have researched the neuroscientific evidence.

Posted by: Sara at July 7, 2008 11:41 AM

If it's 40% of the population, it's not an abnormality. It's a common variant. Calling it an abnormality is just another excuse to pretend it's barely noteworthy.

Posted by: Wendy at July 7, 2008 02:20 PM

Right, so when the Mother's Act gets passed and Momscreen is in every new mother's face. Like Teen Screen before it Momscreen will probably result in suggesting treatment for upwards of 90% of those screened.

Since treatment is always meds and usually anti depressants, I hope the hospitals promoting Momscreen will do the obligatory gene test before handing potentially dangerous toxins to someone whose *abnormal* gene profile won't benefit from it all.

No need to risk new mom's health unnecessarily right?

Posted by: Jane at July 7, 2008 04:27 PM

Apply for a refund? Good idea, as this Cytochrome 450 info has been available for years, and may be in the PDR/package insert info. Class action?

Giving psychoactive meds to people who are of the wrong genetic type can be fatal - and especially so for those of Oriental or Native ancestry. NAMI has an outreach plan (NAMI-MIO)
to bring antidepressants to Native North Americans and Koreans, though. It is at the NAAMI site.

Posted by: Lilly NC at July 10, 2008 10:43 AM

Did I read that right? Did it say that two of the genes involve the brain's inability to absorb or transport serotonin? Am I completely stupid at 6 AM, or would that perhaps have some impact on the underlying problem being treated by an antidepressant? I'm hardly a neuroscientist, but that certainly raises an eyebrow for me.

Posted by: Jordan at July 14, 2008 03:08 AM
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