Australia DNA research aims to take 'trial and error' out of depression medication treatment

01:16  13 july  2020
01:16  13 july  2020 Source:   abc.net.au

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a person petting a horse: Cindy Black has been living with depression for over a decade. (ABC News: Rhiannon Shine) © Provided by ABC Health Cindy Black has been living with depression for over a decade. (ABC News: Rhiannon Shine)

Cindy Black has spent more than four years out of the past decade in hospital being treated for depression.

There have been several suicide attempts in that time, including one that left her in a coma for over a month.

"You just wish you had not got to that point where you felt like there is no other option," Ms Black said.

"It's not a life when you're at that point. It is just existence."

She tried countless medications over the years, but none of them worked.

That changed in 2018, when her doctor recommended that she take a multi-gene test so that a treatment plan could be guided by her genetic makeup.

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Depression treatment takes time. It typically takes up to 8 weeks to feel the effects of medication . Whatever treatment you choose, it’s important to take a proactive approach. Ketamine is the newest treatment for severe forms of depression . The results of esketamine trials were mixed.

As a result, Ms Black was prescribed an antidepressant medication she said had changed her life.

"It has just absolutely changed everything," she said.

"It has brought my overall mood up by 80 to 90 per cent, to a point where I was able to say I am actually really happy.

"I don't think I have ever said that or felt that."

The medication she was prescribed was an old drug which required a strict dietary regime, but Ms Black said it was worth it.

"The benefits of having something that works as opposed to spending another 15 years shuffling around to find something else, is a complete no-brainer," she said.

"If I'd had this knowledge a lot earlier on, things could have been a lot different."

While Ms Black continued to live with depression, her outlook had improved dramatically.

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Traditional depression treatment uses a combination of prescription medication and counseling. That’s because someone with depressive psychosis may experience delusions that cause them to have thoughts of suicide or to take unusual risks.

Patients with depression often struggle through weeks or months of trial - and - error to find the right antidepressant. It's unclear how many patients have had to stop or chosen to stop treatment for depression due to side effects. Ellis tried 23 different combinations of depression medications .

After meeting her partner 18 months ago, the pair got engaged on Valentine's Day and have a baby on the way.

"That has been my ultimate dream, having a family," she said.

"It is unthinkable that, for so long, I did not think that this was going to happen."

Drug 'trial and error' until now

The testing Ms Black took to narrow down her search for the right medication — which involved a brain scan and a cheek swab — is not widely used in mainstream healthcare.

The collected cells are used in a multi-gene test, otherwise known as a pharmacogenomic (PG) test, which surveys around one dozen genes that are known to play a role in metabolism.

The same test will be applied to hundreds of newly-diagnosed patients in WA, NSW and Victoria as part of a study to determine whether first-line medications have a better chance of succeeding if their prescription is guided by the patient's individual genetic make-up.

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Pharmacological Treatment . Antidepressant medications work well to treat depression . And make sure your family doctor knows you are taking medications for an anxiety disorder. Find out how long it should take for the medication to start working and what you should expect when this happens.

Get information on depression symptoms, signs, tests, and treatments for many types of depression chronic depression and postpartum depression . The most prominent symptoms of depression are usually a sad or irritable mood and/or loss of interest in all or most activities that used to be pleasurable.

WA North Metropolitan Health Service psychiatrist Sean Hood said finding the right medication for depressed patients often involved trial and error.

"Most patients, when they get treated [for] depressive disorders, don't get full remission on the first medication they are put on," he said.

"Trialling and looking at different medication therapies can take a lifetime for many patients; it can take many years.

"In the past, it has just been clinical wisdom and therapeutic guessing to find the medicine that is going to be best for that person.

"But this sort of testing hopefully will give us the ability to better target the medications that are going to be suitable for that patient early on.

"I hope this can be a game-changer for the treatment of mainstream depression."

Personalised care may become 'standard'

A personalised treatment plan will also be prepared for each of the study's participants, but only half of the plans will be guided by patients' results — the rest will be developed following current standard-of-care guidelines.

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Everyone’s brain is different and depression -fighting medications are not one-size-fits-all. Unless noted below, there aren’t specific medications that will work better for one type of depression versus another, which is why figuring out what’s most effective for you may take a bit of trial and error .

The researchers relied on the Hamilton Depression scale (HAM-D17), a questionnaire often used to assess patients’ depression symptoms, to track the effectiveness According to the National Institutes of Mental Health (NIMH), 50 percent of people diagnosed with depression use a medication to treat it.

The treatment plans will be reviewed by a national panel of experts to assess whether patients had significant earlier benefit over those receiving standard care.

Office of Population Health Genomics Director Kristen Nowak said although PG testing had been available for many years and there was growing recognition of its value, it had not been adopted widely for guiding medication choice and dosing.

She said if the study proved successful, it could become standard practice in the treatment of depression and be covered by Medicare.

"Given the time, cost and patient impacts of potentially having to try several medications — and the fact PG testing has now come right down in cost and turnaround times — we think there is real value in assessing the potential benefits of more personalised care," she said.

"We're hoping that if the evidence in this clinical trial shows us that doing this test early in a person's health journey can be effective for them then we would strongly consider making that more standard practice here in Western Australia and across Australia."

The trial, which was funded by the Commonwealth Government's Medical Research Future Fund, will enrol 550 patients, including 275 from WA.

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