Brain Scans Seek Best Drug Match for Depression Patients

Depression Seen Getting Drug Right Fast for $2.7 Billion: Health
Prozac capsules. Photographer: Scott Camazine/Getty Images

People with depression often cycle through several drugs before they find one that helps. Now, at least three companies say they can improve the odds that patients get the right therapy quickly.

CNS Response Inc., AssureRx Health Inc. and Brain Resource Ltd. are offering new tests designed to find physical and mental patterns that will predict the best treatment for individual patients. In doing so, they are also creating a new testing market that CNS Chief Executive Officer George Carpenter said may reach $2.7 billion a year in the U.S.

Because there’s no one cause for depression, a disorder that can overwhelm its victims with feelings of sadness, frustration and anger, no single medicine works the same for each patient. That can mean months of experimenting before treatment takes hold, an added burden for people already trying to maintain work and personal relationships.

Prescribing the right drug is “something we’ve struggled with for a long time,” said Philip Muskin, a professor of clinical psychiatry at Columbia University in New York, in a telephone interview. “There are no hard criteria to say, use Prozac or Zoloft or any of the other famous antidepressants.”

About 15.5 million people reported struggling with bouts of depression in a 2010 U.S. survey, and 11 percent of Americans 12 and older are treated for the disorder, according to the Centers for Disease Control and Prevention. Depression costs U.S. employers more than $34 billion a year in lost productivity and, in the worst cases, often leads to suicide, according to the National Alliance on Mental Illness, an Arlington, Virginia patient advocacy group.

Guessing Game

Mark Schiller, a San Francisco-based psychiatrist, said he has seen patients who tried dozens of medicines for their depression without any relief. Now, he uses the CNS test, on the market since May 2011, to help eliminate the guessing game.

The CNS system works sort of like a dating service -- only instead of pairing personalities, it matches electrical activity that’s recorded in the brain.

If a number of people with similar brain waves do well on the same medicine, then that drug will probably work for the new patient as well, CNS’s Carpenter said in an interview. The Aliso Viejo, California-based company has a database of about 8,700 people that new patients can be compared with, he said.

CNS charges a fee of $400 to $800 depending on the type of buyers, and more than 100 psychiatrists are using its data, Carpenter said. The company’s database that doctors access to get the reports was registered last year with the U.S. Food and Drug Administration as a medical device data system.

Life Changing

“I’ve had a number of patients tell me it’s really been life changing,” Schiller said in a telephone interview. “They’ve been in treatment for God knows how many years, never got the right medication, and suddenly we got the right medication and they’re no longer suicidal.”

Worldwide sales of antipsychotic and antidepressant drugs reached $48.8 billion last year, in a global medicines market of $855.5 billion, according to IMS Health, a Parsippany, New Jersey-based industry data company. When they are effective, they’re a boon, allowing people to work and once again enjoy the company of family and friends, said Allen Doederlein, president of the Chicago-based Depression and Bipolar Support Alliance.

At the same time, problems matching patients with the right therapy can often leave them more despondent, and could lead them to abandon treatment altogether, he said. Doederlein said he failed to see any long-term benefit from the first two courses of therapy he was given, before succeeding with a third.

“Giving up is definitely a danger, and something I thought of,” Doederlein said in an interview. “Getting the right medication to the right patient at the right time is kind of the Holy Grail.”

Different Route

AssureRx, based in Mason, Ohio, has taken a different route from CNS with a system that’s based on a genetic test.

The company rates the types of medications patients probably respond to best based on a DNA analysis of how efficiently their bodies metabolize therapies. The test, called GeneSightRx, has sold “thousands,” since it was introduced in mid-2010, said James Burns, AssureRx’s chief executive officer. The company said its test can improve symptoms by 40 percent in people who have failed multiple trials.

Brain Resource, based in San Francisco, offers a simpler approach to the prescription problem. The company has designed a 30-minute cognitive test that evaluates attention, memory, planning, impulsivity and the ability to recognize emotions, said Evian Gordon, Brain Resource’s founder and chairman.

‘High Accuracy’

“Cognition has a very high accuracy in terms of predicting who responds to one of the three most common antidepressants,” Gordon said in an interview. The company is preparing to market its test for the first time next year, and eventually combine it with EEGs, as electroencephalograms are more commonly known, genetic information and brain imaging to find medicines for harder-to-treat cases.

Madhukar Trivedi, psychiatry professor with the University of Texas Southwestern in Dallas, said that while all the options are interesting, more work must be done to identify the physical and mental factors, called biomarkers by scientists, that correlate best with different types of depression.

Trivedi is leading a study funded by the National Institute of Mental Health that’s designed to create a depression treatment response index that may work by combining various types of genetic testing and brain imaging.

“The way to think about it is, how do you fit the full jigsaw puzzle so you’re not just looking at isolated biomarkers,” he said in a telephone interview.

Victor Reus, a psychiatry professor at the University of California, San Francisco, said doctors are eagerly awaiting a tried and proven method. Current products are supported for the most part only by studies that haven’t been repeated or peer-reviewed, or rely on proprietary data not available to the scientific community, he said.

“Everybody realizes there’s a gold mine out there if the results are real,” Reus said in an interview. “Some companies may be trying to sell a product before its time.”

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