Depression

Are you taking or considering antidepressants?

Have you experienced side effects?

Has the medication not had the desired effect?

If you answered yes to any of these questions, you are not alone.

Almost one third of Americans currently take antidepressant medications and many have had problems finding the right drug and dose. This is not surprising to people that study genetics. Research shows that of all the clinical factors that alter a patient’s response to drugs (such as age, sex, weight, general health, and liver function), genetic factors account for a significant proportion.

Virtually all medications used to treat depression are metabolized by two enzymes in the liver: CYP2D6 and CYP2C19. Additionally, response to a group of commonly prescribed antidepressants called serotonin-selective reuptake inhibitors (SSRIs) is affected by the serotonin transporter, 5HTT or the pathways CYP1A2 or NAT2.

Your genes are the main factor determining the level of these enzymes in your liver- if you have too much of the enzyme, you process the medication too quickly, too little of the enzyme and the medication builds up in your bloodstream potentially causing adverse reactions or side effects.

Without knowing your genetics, your physician may need to go through months of trial-and-error prescribing to find the right drug and dose for you.

Population Frequency of Cytochrome P450 Metabolizer Types

Poor(no or low enzyme levels)Intermediate(reduced enzyme levels)Extensive(normal enzyme levels)Rapid or Ultra Rapid(high enzyme levels)
CYP2D610%35%48%7%
CYP2C19*2-20%24-36%14-44%30%
5HTTAbout 40% of the North American population carries a variation that may make them less likely to respond to SSRIs.

 

*CYP2C19 variability depends on ethnicity.

Partial List of Relevant Medications

Elavil®, Endep®amitriptyline
Abilify, Abilify Discmeltaripiprazole
Stratteraatomoxetine
Consonar ®brofaromine
Wellbutrin ®, Wellbutrin XR ®, Wellbutrin SR ®bupropion
Somacarisoprodol
Thorazinechlorpromazine
Celexa®citalopram
Anafranil®clomipramine
Clozarilclozapine
cyamemazine
Norpramin ®desipramine
Dexedrinedextroamphetamine
Ariceptdonepezil
Adapin ®, Sinequan ®doxepin
Cymbalta, Yentreveduloxetine
Lexapro, Cipralexescitalopram
Sedekopan, Pasaden or Depasetizolam
Rohypnolflunitrazepam
Prozac ®fluoxetine
Luvox ®, Fluvoxamine ® Maleate ®fluvoxamine
Nivalin® , Razadyne® , Razadyne ER® , Reminyl®galantamine
Haldol®haloperidol
Fanapt® , Fanapta®Iloperidone
Tofranil ®imipramine
Aurorix ®, Manerix ®maclobemide
Ludiomil ®, Deprilept ®, Psymion ®maprotline
Bolvidon® , Norval® , Tolvon®mianserin
Remeron®mirtazapine
Pamelor ®, Aventyl ®nortriptyline
Zyprexa® , Zyprexa Zydi® s, Zalasta® , Zolafren® , Olzapin® , Rexapin®olanzapine
Seroxat® , Paxil®paroxetine
Taxilan®perazine
perphenazine
Nardil® , Nardelzine®phenelzine
Sparine®promazine
Phenergan®promethazine
Doral®, Dormalin®quazepam
Rozerem®ramelteon
Azilect®rasagiline
retigabine
Risperdal®risperidone
Lexapro®, Cipralex®s-citalopram
l-deprenyl®, Eldepryl®selegiline
Zoloft ®sertraline
tacrine
thioridazine
Desyrel ®, Trazodone®trazodone
Surmontil ®, Stangyl ®, Surmontil ®, Apo-Trimip ®trimipramine
Surmontil ®trimipramine
Effexor ®, Effexor XR ®venlafaxine
Nipolept®, Losizopilon®, Lodopin®, Setous®zotepine
Cisordinol®, Clopixol® or Acuphase®zuclopenthixol

 

Now your healthcare provider can help optimize your response to antidepressants and many other medications by ordering DNA testing. Your results will be entered into our partner precision prescribing analytics software, YouScript. You or your healthcare providers can log in to see if current or future medications are predicted to cause drug-drug or drug-gene interactions so dosage and selection can be catered to your needs. You receive a 30-day subscription free with your testing; additional one year extensions are available for a nominal fee. Of course, your DNA never changes so the testing only needs to be done once in a lifetime.