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Why picking the right Antidepressant Medication to treat your Depression can be difficult

January 6, 2021 joreardon No Comments

Why picking the right Antidepressant Medication to treat your Depression can be difficult

Antidepressant medications remain a cornerstone for the successful treatment of major depression and bipolar depression. If all of them are counted up we have in total about 30 different such medications so in theory at least something effective can be found for each patient suffering from depression. However, this turns out to be much more challenging than might first be apparent.

The explanation is that it is virtually impossible to predict what medication might be best for any one patient. As an example a patient might not respond at all to one serotonin-type antidepressant and respond excellently to another even though both drugs are in the medication class of serotonin selective reuptake inhibitors (SSRIs). In simple terms, a patient has no response at all to Zoloft but then gets a full response to Prozac.

Why such unpredictability for patients?

The answer appears to lie in the complexity of the brain itself. There is estimated to be 400 billion neurons in the brain (as many stars as in the Milky Way Galaxy) and 100 trillion neuronal synaptic connections (perhaps as many stars as in the entire Universe). Therefore the treating psychiatrist is unable to say with any precision what might be the most effective medication for the patient sitting in the office as we have no lab tests or neuroimaging to test in advance what might be the best medication match. Instead a lengthy process of trial and error must begin to find the right treatment. Maybe it will be the first treatment but instead maybe it will be the fifth treatment. It is all rather random unfortunately.

Nowadays genetic testing kits such as Genomind and Genesight make claims that they have short circuited this process and if you have the test your psychiatrist can tell which is “the right drug for you”. These turn out to be exaggerated claims, unfortunately.

A just recently published large scale study of about a thousand patients demonstrated this. Using Genesight testing in advance to pick the right drug improved the outcome by only a small margin, from 20% to 26%. That is correct, using the test as a guide only improved your odds of success by a measly 6%. More in a future post about how psychiatrists try to intelligently pick medications that might have the best chance of helping you.