Genetic testing may help determine the most effective medications for depressed patients in the future. This month, the American Journal of Psychiatry published research citing patients' responses to the anti-depressant medication, Celexa, in association with certain genetic variations.
According to Dr. Gonzalo Laje, co-author of the study and associate clinical investigator at the National Institute of Mental Health, patients were twenty-three percent more likely to respond to the medication when a particular variation in the GRIK4 gene, along with a previously discovered variation on the HTRZA gene, were present.
"We are better able to see how genetic variations help determine how a person may or may not respond to a certain medication. This is an advancement toward personalized medicine," said Laje.
The healthcare and health insurance industries have been plagued with medical and financial issues associated with depression. In 2002, adults served by local mental health authorities in Texas included over 53,000 depression patients -- and that number only includes those who sought care at those facilities, which, by no means, reflected the whole of the depressed populace at the time.
State budget cuts to mental health services would dramatically reduce the number of those able to receive treatment, which would push problems -- many argue preventable problems -- into the emergency rooms. Ninety percent of suicides are due to untreated or under-treated mental illnesses; for Dallas, Houston, and Austin, where facilities are already overwhelmed by the sheer number of uninsured patients seeking care, any further strain could collapse a barely-balanced system.
As the population in Texas state mental hospitals goes down, the prison population goes up. According to the Texas Criminal Justice Policy Council, in 1970, there were approximately 12,400 mental health patients in state hospitals on any given day, including those suffering from depression. That number declined to just over 2,300 by 1999, while the prison mental health population rose to almost 16,000, exceeding the1970 state mental health institute population.
This dramatic increase in prison numbers has not only created problems in the general populace, but has also sucked down state funding. Texas could save an estimated $590 million a year by treating 'revolving door offenders' instead of jailing them.
While the precise number of depressed patients in each state is difficult to determine, according to the National Institute of Mental Health, there are 20.9 million adults in the United States suffering from depression at any given time. That's almost ten percent of the country.
Women are more prone than men, and symptoms are usually recognized between the ages of fifteen and thirty, though the mental health community has been taking childhood and adolescent-onset depression much more seriously in recent years. Severity ranges from mild -- which only slightly impairs functioning, perhaps manifesting itself as one "not living up to potential" -- to severe, which often devastates relationships, income, and day-to-day living, and can lead to suicide.
While depression is considered a treatable disease, just how treatable has been up for debate virtually since the illness began to be studied. Patient compliance has been a major issue, partly due to the nature of the disease itself, which produces persistent feelings of hopelessness, helplessness, worthless, and loss of interest and motivation.
The worse one feels, the harder it may be to feel hopeful and motivated enough to seek, and then follow through with, the proper care. If one does overcome these symptoms sufficiently to accept treatment, various factors, including financial barriers, accessibility problems, and lack of response to medications, can make it difficult to continue the regimen.
Lack of response to medications has been one of the more persistent and difficult obstacles to conquering the condition. For some, the first medication seems to work wonders, but many are not so lucky. Several cycles of different types of antidepressants are often required to pinpoint effective prescriptions, if they are found at all. Choice of medications are many and overwhelming, and include:
• Selective serotonin reuptake inhibitors (SSRIs), like Celexa, Paxil, Prozac and Zoloft;
• Tricycles, like Elavil, Norpramin, Tofranil, Aventyl, and Pamelor;
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), like Effexor and Cymbalta;
• Norepinephrine and dopamine reuptake inhibitors (NDRIs), like Wellbutrin;
• Monoamine oxidase inhibitors (MAOIs), like Marplan, Nardil, and Parnate.
It is believed that the causes of depression are varied, and often depend on the functioning of certain neurotransmitters, such as serotonin, norepinephrine, and dopamine. Though there are commonalities among many of the medications, each can have varying side effects -- some severe – can focus on different neurotransmitters, and can produce different response levels, depending on the patient.
Laje's research could prove to dramatically shorten the lengthy trial-and-error process often necessary for determining prescriptions, as science currently has no truly effective way of profiling patients in this manner. "This [study on Celexa] gives us very relevant information to where we should be looking," said Laje, which is, at least, more progress than Western medicine has made in treating depression for quite some time.
"There's no one marker that's going to tell you whether you respond or not [to medications]. It's a lot of markers, each one having a small effect," said Dr. Julio Licinio, chairman of psychiatry and behavioral sciences at the University of Miami's Miller School of Medicine. "…[scientists] may be able to develop a genetic panel to tell us whether a person is likely to respond to an SSRI or not."
More and more depressed individuals are turning to natural health treatments, however, such as herbs, acupuncture, massage, and other forms of complementary medicine. St. John's Wort (Hypericum perforatum) is the most prescribed treatment for depression in Germany, and is used commonly throughout Europe for mild to moderate cases. Results of studies are mixed, however, and the National Institutes of Health is still undertaking research to determine the herb's effectiveness on mild cases. Other natural supplements used to treat depression include ephedra, gingko biloba, Echinacea, ginseng, various Chinese formulas, and SAM-e, perhaps the most promising natural treatment in recent years.
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