Does Psychiatry Need to Join the Personalized Medicine Party?



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Prescribing a medication or other therapy is as much art as science. Efforts to use blood-based tests for biomarkers and genetic tests to better match treatments to patients make sense. Psychiatrists are joining the chorus in calling for — and exploring — such tests. Yet this approach hasn’t paid off for psychiatry, and is elbowing aside other opportunities to help patients today.

No medication is perfect, and any doctor can tell you that certain treatments don’t work for certain patients. So-called precision medicine tests can help identify whether or not individuals will respond to a treatment.

In cancer, the genetic profile of some tumors can strongly influence the therapy chosen to fight it. For instance, a chemotherapy drug called cetuximab is effective against colorectal cancer when the tumor contains a normal K-ras gene, but isn’t effective against tumors with a mutated K-ras gene. In breast cancer, chemotherapies are often chosen based on the specific tumor subtype, which can be identified by genetic tests.

Despite the tremendous effort being poured into identifying biomarkers to help guide treatment for various psychiatric disorders, this work has yet to significantly improve clinical outcomes.

A big roadblock is that we haven’t yet found strong genetic mutations that can guide treatment for mental health issues. It’s not for lack of trying. In 2013, three large groups of investigators set out to analyze 1.2 million genetic variants in 2,256 patients with depression. They were hoping to find a genetic marker that reliably predicted whether a patient would get better with antidepressant medications.

They didn’t find one.




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