Depression Medication - Same Size Doesn't Fit All

Finnish Media Company MTV reported in May 2018, that in Finland every single day as many as nine individuals are driven out of the working life due to a diagnosed depression. This alarming phenomenon has caused the amount of under 35-year-old retirees to increase for a third during the last ten years. These statistics are mind blowing!

Annarilla Ahtola, the president of the Finnish Psychology Association is flagging for preventive measures to be taken. According to her, the early intervention would have dramatic economic and humane consequences. The earlier the diagnosis is done, the better the recovery rate is. Quite a vast amount of the Finnish people is annually diagnosed with a clinical depression: 5 – 7 % of the population, which is around 200 000 – 300 000 individuals.

As preventive measures play a major role, there will always be a need for medications as part of the treatment plans.  The earlier the correct medication and dosage are determined for the patient, the better the recovery rate is.

PhD Jari Forsström, a specialist in internal medicine, stated at a recently published book by Elina Hiltunen (Masennuksesta selviää! by Docendo, 2018):

“The effect of antidepressants varies greatly amongst the patients. Partly this is due to the fact that the reasons behind depressions vary so much, but also because the response for a particular medicine is individual. Most commonly used antidepressants are citalopram and escitalopram. These medications’ metabolism through the liver has severe variants between individuals. Due to this variance there are significant rates in medicine amounts within the blood – which naturally affect the strength and effect of the medicine.”

Based on this, it is natural to draw a conclusion that genetic testing can assist in choosing the correct and personalized medicine at an early stage of the diagnose.

“Some say that a specific medication has no effect on them, whereas the next person will claim to benefit from it greatly. One reason for this variation is that they are not aware of the vast individual differences and do not realize that they are both correct in their experiences.”

In order for a doctor to improve the patient safety and to enable speedy and convenient recovery, it is important to prescribe the most effective medication. Unique differences in medicine metabolism have been known among the physicians for a long time and the issues of medicine metabolism have also been well documented. Acknowledging these individual differences enables the doctors to improve the patient safety and to offer more effective medical treatment with minimizing the unpleasant or even dangerous side effects caused by the medicines. Currently, the same medication and dosage are prescribed to most patients – regardless of their individual differences. Hence most patients receive the correct amount, but some get significantly too low effect and some might even overdose.

“Some say that a medication has no effect on them, whereas the next person will claim to benefit from it greatly – they are both correct in their experiences.”

Why genetic information is not commonly used in health care?

With pharmacogenetic testing it is possible to determine personalized medicine very accurately. Not all medicines have pharmacogenetic variance, but the ones that have can be fairly simply discovered personally with genetic testing. For a person using antidepressants, receiving suitable and effective medication at an early stage of the diagnose makes a significant difference in the quality of their life. When an individual has been diagnosed, and the doctor has evaluated that antidepressants are needed, it is indeed worthwhile to check the medication’s suitability by a pharmacogenetic test.

It is only through trial and error that the patient finds out about the effectiveness of a medication when a doctor prescribes it for a diagnosed depression for the first time. For example, Jane is prescribed antidepressant XX and she will consume it for the required four to six weeks. In case Jane does not feel her condition has improved she will see her physician again and asks for a new prescription. The wash-out period can be in between four to six weeks before a new medicine can be started. This can be a vicious cycle during which Jane’s depression can deteriorate, or the side effects from an unsuitable medication can make her condition even worse. How can it be determined whether it is Jane’s depression acting out or is she just on unsuitable medication? Eliminating the possibility of the one can be easily solved with a pharmacogenetic test.

The statistics are heartbreaking, but depression is also much more than steep graphics and numbers. On an individual level depression affects also the people around the patient and it can be a long and traumatizing process for recovery.

Currently the individual differences are not being recognized as widely as they could be. How come this development in genetic research is not already being utilized? Is it the responsibility of the Big Pharma, primary health care or an individual?

GeneAccount will open your eyes on how the future of health care will look like.

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