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Mon June 10, 2013
Playing Matchmaker For Patients And Anti-Depressants
One of the toughest things about dealing with depression can be finding the right medication. It can take months, even years. As part of KERA’s Breakthroughs project, here’s a look at one woman’s struggle and the North Texas doctor who hopes to make the medication matching process less like trial and error.
Depression first hit Cindy Johnson in the 90s. She was working an office job in Maine, married, with a daughter in college, when she started to notice she was avoiding everything social.
“I would just get into these crying jags,” Johnson says. “And I finally called my doctor from my office to see if there was anything that could help me.”
There was. An anti-depressant called Paxil. It helped Johnson get back on her feet for twenty years. She started going out to lunch with friends, gardening, and after she and her husband retired they traveled across the U.S. in an RV – landing in Hillsboro Texas, not far from their daughter.
Then, about a year ago, the anxiety came back.
“Just the thought of going to look for flowers, which usually I’d love to do, that’s one of the things that I stopped having any interest in,” Johnson says.
She wasn’t sleeping, didn’t want to leave the house, and her husband got worried. That’s when the drug merry-go-round began. She switched from Paxil to Lexapro to Seroquel – none of the meds helped. After months of trying new combinations and different dosages, her old doctor threw up his hands.
“That’s when he said I’m sorry I don’t know what else to do to help you, this is as far as I can go,” she says.
Ending The Guessing Game
For doctors, it’s largely a guessing game as to which drug will help which person. And each one can take months to kick in. That means someone who’s tried three drugs has spent a year without relief.
Dr. Madhukar Trivedi, a psychiatry professor at UT Southwestern, says that wait time is unacceptable.
“Remember one of the biggest symptoms of the disease is self-doubt and feeling down,” Trivedi says. “And if you take three, four, five months to get them to the right treatment, they lose hope; losing hope is part of the symptom.”
Trivedi says depressed patients often aren’t able to work and they can lose their jobs and friends. Worse, he points out thousands every year take their own lives. So Trivedi is running a national clinical trial* to make matching drugs with patients less like Pin the Tail on the Donkey, and more like Battleship.
“What I would like is to develop an array of biomarkers, biological tests as well as clinical tests, that can be given to a patient that can help decipher what is the best first second treatment for this particular patient.”
The doctor would use something like a blood test and a brain scan to determine how someone might respond to various drugs. This strategy is already being used to treat cancer, AIDS and heart disease.
For Cindy Johnson things are looking up. A few months ago she started a clinical trial for an experimental drug called Ketamine.
“I found out what it’s like to feel good again. That it’s possible to feel good again,” she says.
Johnson says she does still worry the effect could wear off, that she might have to start the search all over again. In the meantime, she’s planted zinnias and columbine in her front yard. She says the bright orange and yellow flowers make her smile, and give her hope.
*You can find more information on the anti-depressant trial led by Dr. Trivedi at embarc.utsouthwestern.edu.