A Colorado based company, Sundance Diagnostics, contacted me a few months ago to tell me about work they are doing to develop a genetic test to predict suicide risk when patients are prescribed antidepressant drugs. Their plan is to sequence the entire human genome of about 360 patients and controls to see if antidepressant drug risk can definitively be predicted.
After my son Toran died as a result of antidepressant-induced suicide, I asked the Coroner to order a DNA test to establish Toran’s metabolic status, he agreed and also agreed to have my blood tested as well.
The tests were conducted and I was advised they showed Toran was a ‘normal metabolizer.’
They did not.
They showed he was an intermediate metabolizer – a result which explains his adverse reaction to the antidepressant he was given. The incorrect information I was given reflects the level of ignorance around the genetics of drug metabolism amongst medical professionals and coroners.
About a year after Toran died, I took my cat, Bug, to the vet and was told he had to have surgery (yes I am telling a cat story, yes there is a point, J). I burst into tears and asked the vet if he might die as a result of the anaesthetic. Bug was my only companion at the time, my only reason for getting up in the morning and filled the need I had after Toran went to continue to ‘mother’ someone. I was so scared that I would lose him and knew I could not to handle yet another loss (yes I am slightly embarrassed at being the quintessential crazy cat lady and trying to justify my emotional reaction – just humour me).
The vet explained that if I wanted, she could conduct a blood test that would show whether Bug had any elevated risk for anesthetic complications.
That got me thinking.
Why was I offered a blood test to assess risk for my cat but not my son?
I geared myself up for a crusade to promote mandatory DNA testing before antidepressants could be prescribed.
Then I did some research and learned that the genes you are born with are one thing but the way those genes are expressed can be something completely different and alter according to your stress levels, smoking, diet, use of medications and a range of other factors.
I became concerned that a DNA test may give people a false sense of security in relation to their level of risk. That people would receive a result showing they were an extensive metabolizer (ie normal) and take the drugs but in fact may not metabolise them normally due to the influence of other factors. Might the test results lead them to be less vigilant about monitoring changes in mood and behavior than they would be without the test?
So I abandoned my plans to campaign for testing and went back to working to ensure people had all the information they needed to make fully informed decisions about using antidepressants and pointing out that the risks outweighed any benefits.
Then Sundance contacted me.
They explained that what they were embarking on was a discovery project and that success could not be guaranteed but that if the project was successful, it may protect children from drug-induced suicide. They explained they hoped to identify anywhere from 50 to 200 markers and that the uncommon markers they identify are expected by scientists to be even more predictive that the common markers we already know.
My initial reaction to what Sundance are doing was to say I couldn’t support anything that might give people a false sense of security around taking antidepressants. That my work is around promoting the notion that environmental factors cause emotional distress and that environmental factors need ‘doctoring’, not the people who are impacted by them. That antidepressants shouldn’t be prescribed for normal human moods and behaviours.
Then I got real.
One in ten New Zealanders is on an antidepressant. Almost half a million people in a country of 4.4 million. Tens of thousands of antidepressants are given to children under 18 in this country despite the fact they are not approved for children. We give these drugs to babies under the age of one.
Of those who have killed themselves under the care of mental health services in New Zealand in the years 2007-2010, 83% were on a psychiatric drug.
What would I say to a mother whose child killed themselves on these drugs who asked me whether my taking the high road on the prescribing of these drugs was more important than giving her information that may have saved her child’s life?
The reality is that despite anything I or my peers do, these drugs will be prescribed to children today, tomorrow and for the foreseeable future. I will continue to advocate fiercely for a social, not medical approach to emotional distress. But I will also let people know that if, despite all the information I and others give them on risk, they choose to use antidepressants, there is a way of reducing their risk using the test Sundance is developing.
Yesterday Sundance sent me a press release they intend to issue on Monday, March 11. It contains the following paragraph:
If successful, the new tests will be available for each patient before a drug is prescribed. The physician can then take action appropriate for the patient throughout the course of therapy. Family members, who before now may not have been advised of antidepressant medications’ side effects, can be informed of the patient’s specific risk and can actively participate in ensuring the safety of the patient during treatment, choosing the level of monitoring warranted and making decisions on complementary therapies and alternatives to medication.
I am pleased they acknowledge that the result of their test may be that people decide not to accept a prescription. I think the very fact that a test exists means that the number of people who take these drugs without knowing anything about the risks of suicide would reduce significantly.
I’ve asked Sundance to share their vision with me and they have said
“What if every mom and dad were to know about the test and would refuse treatment without testing and then really, really consider whether drug treatment is really best at all -- considering that they are informed up, down, and sideways that the risks are there and can't be fully ruled out-- testing or not.
At the end of the study, if we have successfully identified predictive markers, we will be saying to the doctor that we have important information for him about a patient that may be at higher risk but that he should never consider that a patient without the predictive genes is safe from antidepressant-induced suicidal ideation, that he must use his clinical observation, consider smoking, other medications being taken, any medical conditions and social stressors, etc., and still take every precaution imaginable with every patient -- especially with a young patient with a growing and not completely matured brain. We will be giving the doctor much more information than he has now—information that we hope will be critically important in identifying risk — but information that absolutely does not guarantee a patient’s safety. ”
Much of the genetic testing going on at the moment is about predicting who will have a therapeutic response to antidepressants. I think that identifying those at elevated risk for suicidal reactions is far more important.
I would really appreciate people’s thoughts about this.
DelusionNZ: Maria Bradshaw, who currently lives in County Wicklow, Ireland, writes of social models of suicide prevention, pharmacovigilance, and alternatives to psychiatric interventions for emotional distress.