In Practice

A Practicing Doctor's Views on Psychiatry and Contemporary Culture.

Peter D. Kramer is a psychiatrist and author. His books include Against Depression and Listening to Prozac. See full bio

October 17, 2008, Depression

Comments on "Gene Testing for Depression Treatment: Are We There Yet?"

Gene Testing for Depression Treatment: Are We There Yet?

By Peter D. Kramer on October 17, 2008 in In Practice

Before you take an antidepressant, should you get your genes catalogued?
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How do genes relate to severe toxic reactions?

Submitted by MH on October 19, 2008 - 12:14am.

Thankyou for your interesting article.
I suffered a severe toxic reaction to Zoloft(sertraline) in which I suffered severe akathisia (agitation and restlessness) and panic attacks, and I became suicidal (I was prescribed the drug for fatigue and had never been depressed before). I have recently had the gene testing and I found that I was deficient in cytochrome 2C19, which according to recent research is needed to metabolise zoloft.
In your article you talk about the way that gene testing could predict who would need less and who would need more of a drug, what about predicting who should NEVER take the drug in the first place? Is it generally accepted that my gene test explains my extreme reaction to zoloft? Should patients be screened with this test in order to ascertain whether they are at risk of akathisia and therefore suicidality and homicidality?
Thankyou
MH

Zoloft

Submitted by tessa on October 19, 2008 - 9:11am.

I took Zoloft (from the same SSRI drug family as Prozac)years ago and experienced the same side effects you describe. I haven't undergone gene testing. I do realize now that I was misdiagnosed with postpartum depression after succumbing to postpartum thyroid dysfunction. I had a reactive depression.

You ask yourself along with your psychiatrist whether your depression was reactive or biochemical.
I was depressed for two years and antidepressants did very little to alleviate my depression b/c the source of the depression was still present in my life.
I remember the attending psychiatrist at Harvard UHS telling me ominously that people who become depressed once will be much more likely to fall depressed again and again and again. Cheerful fodder for an already depressed person.
I do believe in the power of physical exercise, all forms of positive sociability, and meditation in overcoming problems of the mind as well as external circumstances which help to create depression. I personally do not believe that antidepressants help, in the long term, with a reactive depression.