According to the World Health Organization, nearly 4% of people experience depression at any moment in time. This includes 5% of adults with more women than men by 6% versus 4%. This comes to about 280 million people worldwide. The economic burden of depression is more than $200 billion a year in the USA. Depression is one of the risk factors for suicide, especially among military veterans. As often as not the first antidepressant medicine that a person takes does not work. Fortunately, genetic testing to pick the best antidepressant may be of help. This is called pharmacogenomic testing.
What is Pharmacogenomic Testing?
According to the CDC, pharmacogenomics is a way to see if a given medicine will help a person or cause adverse reactions. In order for a medicine to work on a person it has to attach to a receptor at a molecular level throughout the body. Not everyone has the same types of receptor with the same proteins in the same proportions. This is determined by a person’s DNA. Pharmacogenomics is the science of sorting out what kinds of genes you have, what kinds of receptors you have, and how those receptors will affect which medicines will be most helpful or cause problems.
Practical Application of Pharmacogenomics for Depression
Doctors at the University of British Columbia have been using pharmacogenomic testing to help pick the best antidepressant for depressed patients. They are very excited about the prospects of genetic testing in this regard. This sort of testing is targeted and not used to screen everyone. Rather it is used when a depressed patient needs medicine. The problem when choosing an antidepressant is that there are dozens to choose from. More than half of the time the first antidepressant does not work very well and another, and another has to be tried. And about a fourth of those treated have adverse side effects and have to change medicines. Using pharmacogenomics they find that they can make better choices when picking antidepressants that will work the first time, work the best, and not have any bad side effects.
How Useful Is Pharmacogenomics For Picking Medicines?
Current evidence indicates that 42% of the factors that affect how people respond to medicines come from their genes. Genes affect how drugs are metabolized which is a big factor in how antidepressants work and their side effects. Likewise they affect where and how well the drugs work their effects. The researchers say that by using this approach in choosing antidepressants that treatment-resistant depression would be reduced by 37%. People will spend 15% less time being depressed over the years if this approach is always used when they need medicine. In addition there will be fewer deaths and fewer hospitalizations over the years.
Who Pays for Pharmacogenomic Testing?
This study was done in Canada where there is a national health care system as well as various private insurance companies. The national health service does not currently pay for this kind of testing while some insurance companies do. The issue on the part of both insurance companies and the national health care system is typically one of cost. To the extent that enlightened self interest is concerned, it should be a cost to benefit ratio but that is not always the case with shortsighted corporate and governmental entities.
Would Widespread Pharmacogenomic Testing Save Money?
The researchers at the University of British Columbia make a good argument for this approach saving money. People would take fewer drugs that did not work and stay out of the hospital which, in the case of the healthcare system, the government pays for. Fewer would die which, in the view of insurance companies and governmental bean counters would not make a difference in regard to costs. Or it could actually save the national health care system money!
Would Widespread Use of Pharmacogenomic Testing Save Lives?
Here is where we at No Fallen Heroes become especially interested in this approach. Depression is a major risk factor for veteran suicide. The quicker that a depressed person gets appropriate treatment and gets better the less is the risk of suicide. When this approach is used a person will spend less time being depressed over their lifetime. This looks to us like an approach that would save veterans’ lives. As such it should be applied as expeditiously as possible to treating depression across the board.