Posted by Tomatheus on November 27, 2005, at 23:19:49
In reply to Re: where to get Serotonin Transporter gene testing?, posted by jamestheyonger on November 27, 2005, at 22:46:49
> People on this site say over and over again
> a more specific Dx does not yield better treatment.How many people on this site have had their doctors consider genetic testing results as part of their treatment plan?
>
> Did you see this part:
>
>
> “Genes don’t directly encode for psychopathology, hallucinations, delusions and panic attacks. Rather, there is a very complicated path between a gene’s influence on the regulation and function of a protein and such psychiatric phenomena,” added Weinberger"Yes, and I have acknowledged in my previous posts that the path between the influence of a gene and psychiatric illnesses is indeed complex. There is absolutely a lot more that needs to be learned about the relationship between genetic variations and psychiatric illnesses and depression. But I still think that the knowledge of any potential genetic diatheses that contribute to patients' psychiatric illnesses would be a valuable tool for psychiatrists because, in some cases, it would enable them to consider treatments that they might not have otherwise considered.
> One small study of just 27 people proves nothing. When does the study mention long term outcome ?
> I got the feeling this study lasted a few hours
> and only measured monoamine levels, not if the patient did better. This makes the study an interesting theory which is not relevant to clinical practice till more information is gathered. I would not think, having taken amphetamines, that they would not be a good long term treatment for schizophrenic patients.I do agree that more information should be gathered before amphetamines are recommended for the treatment of schizophrenia. But what is relevant about this study is that it illustrates that some schizophrenic patients (note: I do not say all) actually have a genetic variant that indirectly lowers dopamine levels (and the fact that they are responsive to amphetamines, even if only in the short term, provides evidence that blocking dopamine receptors is counterproductive in the treatment of certain schizophrenic patients). If nothing else, the knowledge that a schizophrenic has this genetic variant could lead psychiatrists to prescribe a more stimulating antipsychotic (such as Abilify) before prescribing one of the more sedating ones.
> I find amine theories very suspect as the cause of mental illness. We have many drugs that effect them and none of them cure mental illness and are far less that 50% effective in general populations.
Well, I suspect that there are a few reasons for this. One is that (as genetic association studies suggest) most psychiatric illnesses are heterogeneic. If there were, for example, five different genetic diatheses for depression (I'm aware that there are probably more and that there are a lot of causal factors that we are still likely unaware if, but I'm using this for example's sake), why would a patient with diathesis No. 1, for example, respond to a drug in the same way as a patient with diathesis No. 2 (or No. 3, No. 4, or No. 5). Another factor is that the drugs prescribed for a given illness may not necessarily adequately "normalize" a patient's genetically mediated biochemical abnormality.
> Anyway, this issue is moot to me, as these tests are not used outside a research setting. I am not saying they will not be at some point once we have real solid reproducible research. If you have a gene how likly are you to get X ? IF genetic testing says a med will improve something
> will you tolerate it and will it improve long term outcome ?I agree that more research is needed and should continue to be done. But I think this line from earlier in this post best sums up my position on this issue: "I still think that the knowledge of any potential genetic diatheses that contribute to patients' psychiatric illnesses would be a valuable tool for psychiatrists because, in some cases, it would enable them to consider treatments that they might not have otherwise considered."
Tomatheus
poster:Tomatheus
thread:582481
URL: http://www.dr-bob.org/babble/20051126/msgs/582874.html