Jan Northam is a retired nurse. While working in the ER, not long after Prozac came on the market in the late 1980s, she discovered the medication tremendously helped her depression.
“I had a friend that I worked with who was taking it. And I said, 'Dang!' We worked the emergency room. 'I want to feel like you. You are handling things so well,'" Northam says. "You know, 'cause, sometimes you’re overwhelmed and you want to walk out for a while and you know, you can’t."
She stayed on Prozac for years, paying out of pocket for the name brand because she thinks generics don’t work as well. When she retired, she could no longer afford the $450 a month, so she tried a generic but wasn’t happy with the results. When her physician retired, her new doctor put her on Lexapro. It helped only a little, at first.
“I just lost motivation to do stuff. I wasn’t like curled up in the house or anything like that but, the theory behind the Lexapro was that I would have more energy, more want to do things," Northam says. "I was short tempered with my grandkids – my kids too. I mean it just came out of the blue. That’s not good, and that was not me.”
As her depression worsened, Northam found herself thinking about suicide – something she says she would never seriously consider because of her family.
Then, when Northam had to change doctors again, she found a new ally in her fight against depression.
Beth Buchanan is a family practice physician who has been in practice over 30 years.
She practices in Shelbyville – and recently learned about pharmacogenomics, or DNA testing, to help rule in or out the best antidepressants for an individual.
“It’s totally about metabolism," Buchanan says. "And I want to be clear that it doesn’t predict what medicine will work well for you. It doesn’t predict efficacy, but it might explain lack of efficacy.”
Northam took the test and the results came back showing Lexapro isn’t a good genetic match. She doesn’t metabolize it well. So she and Buchanan agreed to try one from the list her body would metabolize. They once again tried a generic version of Prozac. This time - it’s working.
And she’s grateful for the test.
“If nothing else, I think it takes away that trial and error because you don’t have time for that," Northam says. "Once you start that downhill slide, you don’t have time, 'cause it’s gonna get worse.”
Refining the genetic tests
Northam's metabolism test helped rule out drugs that wouldn't work, but what if doctors could accurately pinpoint those that would?
Dr. John Nurnberger is a professor of psychiatry at Indiana University School of Medicine and has been working in psychiatric genetics for about 40 years. He says clinical trials with Assurex -- the company that created the genetic test Northam used -- are underway at IU now, and part of the study is to determine from a genetic standpoint which drugs will best treat an individual patient's depression.
“Not so much how the body metabolizes the drug," Nurnberger says, "but how the body responds to the drug – that is – what the receptors do and how the drug interacts with the receptors in the brain."
And he says by Assurex and other companies refining the genetic tests, there’s hope even more of the trial-and-error in prescribing anti-depressants will go away, fast tracking relief for people like Jan Northam.
While Northam is thankful for the metabolism test, she discovered the hard way that Medicare only covers it - at this point - if it is ordered by a psychiatrist. Medicare rejected paying for it. Northam is appealing.