Did you know that as much as some doctors and researchers like to think that medicine is a science, it is very much an art too?
You can see that no more clearly than in the decision process doctors use to prescribe a specific psychiatric medication. Ask a psychiatrist what their usual depression treatment regimen is, and they’ll usually talk to you about using one or two different antidepressants they are most familiar and comfortable with prescribing — not which medication is best for the patient.
Why is that? Wouldn’t you like to prescribe the most effective medication for a particular patient based upon their brain’s chemical structure and likely reaction to it? We sure would, but until recently, we had few ways to determine how a person might react to particular antidepressant medication.
Luckily, the days of trial and error and guesswork in this particular area of treatment may be coming to an end.
A new medical test — called a biomarker test — appears to help predict a patient’s response to a specific antidepressant. The test is non-invasive, painless and fast, taking about 15 minutes. Six electrodes (which measure brain activity) are placed around the forehead and on the earlobes (the electrodes don’t hurt — they are only measuring devices).
Here’s what the study found:
Subjects were then randomly assigned to continue with escitalopram or were given a different drug. A total of 73 patients who remained on escitalopram were tracked for 49 days to see if their results matched the prediction of the ATR biomarker. The ATR predicted both response and remission with an accuracy rate of 74 percent, much higher than any other method available.
The researchers also found that they could predict whether subjects were more likely to respond to a different antidepressant, bupropion, also known as Wellbutrin XL.
So although this test only worked on two medications — Lexapro and Wellbutrin XL — it’s a very good start in this area. And while 74 percent may not seem high, it’s much better than the current prescription strategy of trial and error, where only one-third of patients will respond to the randomly selected antidepressant medication they are prescribed (according to STAR*D, and then it’s more trial and error for those remaining two-thirds).
This test also shows the likely future of medical tests for serious mental conditions such as clinical depression. Rather than traditional blood-work laboratory tests, we’re far more likely to see these kinds of brainwave measuring devices. Such devices help collect data on how our brain is functioning and reacting, without any needles or pain. And while we’ve long been aware of their usefulness for a wide range of applications (from brain research to neurofeedback treatments), this is the first study of its kind demonstrating a simple way to discriminate between drugs and their effectiveness in our brains.
I can imagine that perhaps in a few more years, we’ll have biomarker tests for virtually all psychiatric medications, taking a large part of the guesswork out of the equation. And providing patients with better, more targeted care, more quickly.
Read the full article: Test Selects Best Depression Medication
9 comments
I know that each patient must be treated on a case to case basis, but this is the first time I read someone say that med people prescribe based on their own “art”. Anyway, I hope things do get better.
Cheers!
– Barry
interesting post. escitalopram is lexapro, not one of your favorites i think.
psychopharmacologists are very good at prescribing these sorts of drugs while regular mds are not experienced enough. and it does take a few weeks to get a therapeutic effect out of ssri-s.
i suppose some insurance companies will want to speed the process along with this sort of testing if it gets people back to work faster.
i happen to take both drugs mentioned (wellbutrin and lexapro) at different times of day. there are a lot of good reasons for doctors to write scripts for drugs they understand very well even if something different more expensive and potentially better is out there. i don’t consider the doctor’s decision to be a ‘mistake’ just because he/she doesn’t prescribe the latest and greatest.
knowing the track record of a drug prescribed for long term care is very important. as an example, the new breed of anti-psychotics give amazing results with fewer discomforts and higher costs. but the long term effects are just becoming known and one might not want to take them.
i seem to recall that marker tests like the ones prescribed here have been successfully used in my area for prescribing chemo-therapy.
but in the case of depression, if a drug doesn’t work you just try something else.
it is often the case with antidepressants that ones working on different receptors are mixed in prescription to kick start each other. your ordinary md probably won’t do this because it is outside the range of his experience. fancy tests are no substitute for a good psychopharmacologist at least not yet.
and let’s hope that doesn’t change too soon or insurance companies will drive them into extinction.
I like my clinical skills better: i just throw a dart at a board that lists all the antidepressants on it and the hit hopefully isn’t a miss!
Seriously, when the facts of this test are fully vetted, we’ll find out who is behind this sham and it will be a pharma company, I will not be surprised as who else benefits from this alleged test. Did they find a marker for placebo, because that is an element to the process too?
Who believes this crap anyway? A dumbed down, quick fix seeking, no interest in effort public, that’s who!
Does the test come with a contract to buy the Brooklyn Bridge too?!
skills, they are though doing this research with cancer drugs, and already are applying this as well. There is a CA company, I forgot the name. Supposedly, they analyze your individual cancer tissue and subject it to many different chemotherapeutic agents, and then give you the results. The results will then aid your own oncologist in deciding what will work best for the individual person. It is though not that useful for people who have already been treated, and to provide a specimen of the already treated tumor.
The whole thing does make sense to me. I recall the charge for this testing was/is a few thousand dollars.
Hi John,
I recently read an article that informed me of a biomarker test that can detect, confirm or rule out Alzheimer’s disease at the earliest of concerns;
Having been validated by University of Pennsylvania School of medicine. The test worrks by measuring cerebrospinal fluid (CSF) concentrations of two of the disease’s biochemical hallmarks – amyloid beta42 peptide and tau protein – the test also predicted whether a person’s mild cognitive impairment would convert to Alzheimer’s disease over time. Researchers were able to detect this devastating disease at the earliest stages, before dementia symptoms appeared and widespread irreversible damage occurred.
Marvelous!!
Regards
Dawn Pugh
This is an interesting breakthrough. It is too bad that so many of these medications have adverse affects after short and long term use that are hard to gage prior to starting treatment.
Depression is a condition of general emotional dejection and withdrawal. This disturbance of mood is characterized by a loss of interest or pleasure in normal activities and can affect anyone.
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WTF!!!!!!!!!!!!!!!!!!!!!