Genes R US — Gene tests reduce trial and error for brain meds

Posted: Wednesday, April 18, 2012 5:00 pm

Last week The Tennessean published an article regarding the use of gene-based tests to reduce the trial and error associated with finding the right antidepressant medication. (http://tnne.ws/Jkr8Ol) I was asked for my opinion on the tests and which of the two tests is best. Okay, I’ll get there … but first, some background.
These gene tests help refine and validate a broad class of medications used to treat a wide range of brain disorders including but not limited to depression. These disorders are as varied as bipolar disorder, schizophrenia, anxiety disorders, obsessive-compulsive disorder, attention deficient (and hyperactivity) disorder, weight loss and treatment-resistant headaches. 
Depending on an individual’s DNA, brain hormones (like serotonin, norepinephrine and dopamine) may or may not be efficiently targeted by certain prescribed medications. Other genetic variations impact a medication’s potential to calm overly excited neuronal connections. (Check out this video for a better understanding of the science http://bit.ly/sDgrTe.)
Most medications are metabolized in the liver. Variations in our DNA can make that process super fast or very slow — which has implications for dosing and, hence, toxicity. And finally there are genetic variations that increase the likelihood of certain medications helping you pack on the pounds — without trying. 
To form an opinion about these two gene tests, I did what anyone could do. I read the websites for the two companies, AssureRx and Genomind. Next I called each company and asked to speak to their Chief Scientific Officer or their Director of Marketing. You may not feel comfortable doing this part — but this is in my comfort zone.   
Both companies were eager to share information about their gene test products. Well, except for pricing information, which they cannot shar,e as I am not a medical doctor. Both companies provide financial assistance that makes their gene tests affordable to all, or even free in some cases. But with additional investigation I found that the tests are far less than the usual cost of the blood work for your annual physical. And the gene tests are covered by most medical insurances.
One company uses a saliva sample for DNA analysis, while the other company uses cells scraped from the inside of one’s cheek. Currently each company tests which versions of six to 10 genes are present. They do this by testing for a whole bunch of SNPs. SNPs are single point differences that take on one of two values in the DNA from person to person.
Rather than recommending one gene test over the other in my column, I see my role as getting these tests used and adopted in the clinic. Unlike the direct to consumer genetic tests (think 23andme), you can’t order these gene tests yourself. 
Some doctors are really interested in this brave new world of personalized medicine and others, well, not so much so. But let’s suppose that you have convinced your doctor to order one of these gene tests for you. What needs to happen?
First the physician needs to register with the company that sells the gene test you plan to use. He and his staff will get some training on proper sample collection (spitting and scraping). A company representative reviews the test report with the medical staff to ensure that there are no questions on interpretation. From sample to report takes 24 hours or a couple of days, depending on the company selected.
Because one of the two gene tests has been on the market longer, I was able to find an image of the report from about a year ago (http://bit.ly/HKt2O9). The report is easy to understand, assuming one has knowledge of which medications are prescribed for brain healing.
Your doctor should be familiar with every medication on this list — or you are seeing the wrong doctor. Sorry, but this is your brain we are talking about here.
Beyond that, however, no special education in genetics is required to translate the report directly into which medications are best for you — or not — and which ones should be watched most closely for side effects.
Those of us that have gone through the trial and error process for brain meds — even for something like 24/7 headaches as I did seven years ago — can surely appreciate the utility of such gene tests. My anxiety would have been considerably lessened at the time if such a gene test were available, given the complex cocktail needed to return my quality of life.
I believe that each of us can make a difference in how readily personalized medicine is utilized in the clinic.  These gene tests are a great example of personalized medicine. Your first step is to educate yourself. And if you made it to the end of this column — you are well on your way.
Editor’s note: Nancy Miller Latimer has worked in scientific research and development for 27 years. She blogs at NeuronalBeauty.BlogSpot.com
Published in The Messenger 4.18.12