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If you’ve ever taken medication for depression (or know someone who has), you may have found that it either didn’t work, or it took a fair amount of trial and error before your doctor found the right medication and the right dose – the one that was both effective without causing intolerable side effects.  Wouldn’t it have been great if you could have just taken a simple blood test first to see if the medication was going to work for you?

Well, that may be a possibility thanks to recent research conducted at Loyola University Medical Center in Maywood, Illinois.

Scientists at Loyola may have discovered the key to determining if a patient was going to respond to a medication or not.  The “key” is VEGF – which is short for a particular protein in the body known as vascular endothelial growth factor.

The Loyola study focused on patient response to a particular antidepressant – an SSRI called escitalopram (brand name Lexapro).  SSRI stands for “selective serotonin reuptake inhibitor”.  Medications in this category work by targeting serotonin, a neurotransmitter in the brain that helps regulate mood.

Thirty-five individuals with major depressive disorder participated in the study.  They were taking escitalopram to treat their depression.  Of the patients who had levels of VEGF in their blood that was much higher than normal, over 85% responded well to the medication – i.e., it gave them either full or partial relief from their symptoms.  For those whose VEGF levels were lower than normal, less than 10% responded well to the medication.

This study shows that a blood test for VEGF would be a very good predictor of whether or not an individual would respond to the medication.  Since nearly 2/3 of people who take antidepressants don’t have a good response to the first medication they are prescribed, a blood test like this could save a lot of unnecessary trial and error.

Trial and error with antidepressants is not only expensive (especially without health coverage); it is also frustrating to someone who desperately wants relief from depression.  Unlike some medications, antidepressants don’t work quickly.  It can take a few weeks before experiencing any positive effects – so the process to find the right medication can become quite involved and go on for many weeks or even months.

Although depression is one of the most common psychiatric disorders, afflicting millions of people, it can significantly interfere with a person’s life.  Symptoms include a sad or depressed mood, low energy, difficulties with concentration, problems with sleep and appetite, and feelings of worthlessness and hopelessness.  Many individuals with depression also experience suicidal thoughts – thoughts on which they may act if their depression is severe enough and if they don’t get treatment.

When these symptoms are preventing people from performing well at work, home, or school – or interfering with their relationships or overall quality of life – several weeks or months without relief can be costly in many ways.  It can also feel unbearable – and even make their depression worse as their lives fall apart as a result.  A blood test that predicted medication responsiveness could make a significant difference in terms of quickly finding the right medication – or determining if medication was going to be beneficial at all.

The two standard treatments for depression are psychotherapy and medication.  Although many mental health professionals don’t recommend antidepressant medication as the sole treatment for this disorder, it is widely prescribed as such.   This is often because, compared to psychotherapy, antidepressants are generally less expensive, much easier to access and take, and more convenient than going to weekly therapy sessions for several months or longer.

Unfortunately, antidepressants don’t work for everyone – even after much trial and error.  Researchers don’t know the exact reasons why this is.  One reason may be that different individuals have different underlying causes for their depression – including different brain chemicals being out of balance.  Serotonin is the only neurotransmitter involved in mood regulation – if it’s not out of balance then an SSRI may not help at all.

Medications like escitalopram help balance brain chemicals.  They may also help regenerate inactive brain cells in individuals with depression.  This regeneration process is known as “neurogenesis”, and VEGF helps to facilitate it.  In this particular study at Loyola, the researchers at Loyola found that the escitalopram stimulated these atrophied brain cells.  When they’re restored and become active again, the symptoms of depression decrease.

Although experts have learned so much about the brain in recent years, there is still much that is not yet understood – particularly when it comes to the role brain chemicals play in various psychiatric disorders.

Although many more studies need to be done, the hope is that a reliable blood test could be developed and used by doctors and other prescribers.  Individuals who had a low VEGF level might benefit from another type of antidepressant (e.g. a tricyclic or atypical antidepressant) or work with a psychotherapist.

It will be interesting to see how this unfolds.  Of course, more research needs to be done. But for anyone with depression, studies like this can provide a lot of hope.  The ability to predict medication response could significantly streamline the treatment process and help depressed individuals quickly get on the right track in terms of the best type of treatment.  The less trial and error involved, the better it is for the patient.



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