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DEPRESSION

There's A Gene Test That Tells You Which

Antidepressant Will Work Best
Emily Glover
EG
Nov 18 2016, 10:30pm

One womans unusual experience highlights the potential of

precision medicine.

Michayla Sullivan doesn't remember pleading with her mom to chop o her
hair, convinced it was on re. It's just one of several incidents that she no longer
recalls. In its place are hazy recollections of conversations about group homes
and medications. The pills always seemed to do more harm than good, she
thought, but she trusted her doctors knew what was best for her.

Not long before then, Sullivan had been a law student at the University of Notre
Dame. Like many of her sleep-deprived, overworked peers, she often felt
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lethargic and generally down. She went to a clinic andwithout much more
than a brief consultationwalked out with a prescription for an anxiolytic, an
anti-anxiety medication. If she didn't feel better, she was told, she could come
back and try something something else.

This is a familiar process for theestimated 43 million American adults who are
currently being treated for some form of mental illness: Just take whatever the
doctor gives you. Wait a few weeks. Don't feel better? Get another script.
"Generally you wait at least six weeks and also try to get to the maximum dose if
tolerated by the patient before switching or adding another medication," says
Celia Trotta, a board-certied psychologist in New Jersey.

For most people, this process of trial and error works. But for an estimated 10 to
30 percent of patients being treated for depression, the outcome is less
predictableand the consequences can be dire. Side eects of common
medications like Ativan, Xanax and Busparcan include extreme exhaustion,
hallucinations, and confusion.

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For Sullivan, that initial medication was only the rst in a line of drugs that
weren't just ineectivethey were actually harmful. Within one week of picking
up the prescription, her anxiety progressed to the point of active paranoia.
Another week later, Sullivan's parents removed her from school and took her to

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the hospital on the advice of another doctor. "This just kind of began two years
of them not really understanding what was wrong with me," she says.

The following months were lled with a stream of new doctors and medications
no one was able to provide a proper diagnosis. "Some of the symptoms t, but
none of them were ever quite right. So they kept trying new medications, which
caused new varieties of what I now know were side-eects," she says. She
experienced hallucinations, and became unable to care for herself. "I looked like
I had mental illnesses that I didn't actually have, so they would try to treat
them."

Even now, those two years are a blur. The only evidence she went on entire trips
with her family are the pictures they have. She may introduce herself to
someone only to learn they've met before. The days blended together as she
slept for long stretches. She considers these gaps in her memory to be something
of a good thingwhat was going on wasn't something anyone would want to
remember.

"My parents and I were starting to look at group homes for long-term care," she
says. "They were changing their will and talking to my sister about providing for
me because it looked like I was going to be unable to care for myself the rest of
my life."

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That was until Sullivan's doctor recommended a pharmacogenetic test called

GeneSight, which involves taking a swab of the patient's mouth to look for genes
that break down active ingredients in common medications. The doctor wasn't
overly optimistic that it would solve Sullivan's problems, considering none of his
previous patients were shown to have any genetic abnormalities. But Sullivan
wasn't like most others, as the results proved, according to Sullivan: "It turns
out I can't metabolize any antidepressants, any anxiolytics, at al," she says.
"And what was diagnosed as depression in the rst place was probably
hypothyroidism exacerbated by law school."

With those results in hand, Sullivan's doctor began weaning her from the
medications, which Sullivan says took several months because she had been
"essentially overdosing on them" for the better part of two years. But even the
worst of the withdrawal symptoms were worth it to her because, as she said, she
is now a "normal, functioning member of society," which was something that
seemed out of the question just a few years ago.

Prescribing medication is far from an exact science, as Sullivan's experience

illustrates. "If a medication does not seem to be working, options include
increasing the dosage, switching medications, or adding a second medication,"
Trottaexplains. The makers of pharmacological tests like GeneSight, as well as
other, similar companies likePGXL Laboratories and YouScript, hope to help
doctors nd the precise level of medication that works for each patient's unique
physiological makeup.

Research is still ongoing into the accuracy and eectiveness of these tests. In the
meantime, physicians seem to be gradually buying into their promise. A recent
study inPsychiatry Research found that 80 percent of doctors who used a
pharmacogenetic test believed it would become "common standard in
psychiatric drug treatment." They've also received federal endorsement: In 2015,
President Obama launched the Precision Medicine Initiative, noting that genetic

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tests "can help identify the best drug for each patient and speed eective
treatment."

The potential upside of pharmacogenetic tests may be strongest for patients

diagnosed with mental illnesses. In one study of 165 patientswhich was
funded by Assurexpatients who had genetically guided medications saw an
average 70 percent improvement in depressive symptoms within eight weeks.
Another independently funded study published in The Primary Care Companion
for CNS Disorders in 2015 analyzed data from 685 patients with mood or anxiety
disorders. The researchers found 87 percent of the patients "showed clinically
measurable improvement" three months after their physicians used
commercially available genetic tests, though the researchers note they didn't
have a treatment-as-usual control group.

While promising, it may be too early to tell if these tests are as eective as they
seem, says James Evans, professor of genetics and medicine at the University of
North Carolina. "There have been small studies that indicate that some of these
tests may guide therapy. My general, feeling though, is that it's really not ready
for primetime," he explains. "I want to make sure that when I do a test on a
patient that there's good science behind that show it to be eective. Otherwise
we're practicing medicine through anecdotes."

For someone who is one of those anecdotes, it's a dierent matter. Says Sullivan,
"I don't think I'm being melodramatic when I say that test saved my life."

Image:Stephanie Santillan

MENTAL ILLNESS FEATURES MEDICATION MIND ANTIDEPRESSANTS READ

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GENE TESTING

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22:10

The Experimental Ketamine Cure for Depression

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SORRY NOT SORRY

We're Going to Ruin the Eggplant Emoji for You Now

Mark Hay
Apr 26 2017, 1:36am

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Image: Emojipedia

Unless you're into penis fractures.

In the six years since Apple added it to its standard emoji keyboard, the eggplant
has gone from an innocuous vegetable to America's favorite shorthand for a
throbbing cock. By 2015, the year emoji regulator Unicode admitted the
eggplant's connotations to itself, a study showed that of a billion emojis sent
worldwide, a million were eggplants, mostly sent in the US and Canada for
raunchy reasons. Cultural critics have spent gobs of time puzzling out why a C-
list veg, with no previous erotic connotations in American pop culture, rapidly
took on this tinge. Unknown to most of them, and likely to most who sexualized
the fruit, in one medical discipline eggplants were associated with dicks pre-
2011. But the connection was (and is) so horric that today some doctors are
utterly bewildered by the eggplant's current prevalence in horny "u up?" texts.

An "eggplant deformity" is, in urological circles, a sign of a penile fracture,

which is even worse than it sounds. During sex, masturbation, or freak
accidents, a penis can bend so forcefully that the sheath around one or both of
the spongy tubes holding the blood creating an erection tears, audibly and
painfully, resulting in rapid accidity. The blood released often pools inside the

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battered cock, causing bulbous purple-black swelling that makes it look more
like an eggplant than when it's happily erect. If the tear is severe enough, a
patient may piss blood as well.

Specialists in urban centers only see one or two fractures a month, so they're
rare even if they are likely underreported due to shame, and steps can be taken
to minimize risk. They're easily xed by a one-hour procedure and two months
of penile rest. Barring delayed treatment, side eects like long-term pain or
permanent curvature are rare. So it's always been a marginal issue. Boston
urologist Robert Hartman notes that a penile fracture did appear on Grey's
Anatomy in 2009, but eggplant deformities didn't come up. That term didn't
gain mass media recognition until Hartman put a (NSFW) photo of the deformity
in the New England Journal of Medicine in 2015. (It's been mentioned in
subsequent tabloid coverage of inexplicably prominent penile fracture cases.)

For anyone without knowledge of this medical context, urologist Ryan P.

Terlecki of Wake Forest Baptist Health gets why the eggplant was a good
eroticization candidate. "If you look through the standard emojis on the iPhone,
the eggplant [a skinny Asian variety versus the fat ones often found in the US] is
the most phallic The banana has an associated peel and the cucumber is
already cut in slices," he says.

Still, adds Benjamin L. Cooper of the University of Texas Health Science Center
at Houston, "I do nd it horribly ironic that the eggplant is used as a symbol for
an erection when in fact the eggplant deformity is a broken erection, a
fractured penis that has completely detumesced." (That's un-hardened, for the
non-urologists.)

Hartman wonders if the eggplant emojis could generate awareness of penile

fractures. "If an emoji is capable of social awareness and behavioral
modication," he says, "then long live the eggplant." But Cooper and Terlecki
think the community using the term "eggplant deformity" is so small that few

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emoji users will learn of it, even when it does make the papers. And its sexual
meaning is so widely established that, even if they do, their views and use of the
fruit likely won't change.

For the few Americans who built their rst dick-eggplant associations in med
school pre-emoji, or for young doctors encountering the deformity on a regular
basis, though, the emoji will always carry a cringe-worthy irony. "I love the idea
of a student sending what he thinks is a forward borderline sex-pest 'let's hook
up' text to a [medical] student," says Gavin Lucas, a British emoji authority,
"not realizing that the text could be interpreted very, very dierently."

Read This Next:Ejaculating Blood is a Thing That Happens

TEXTING SEXTING EMOJIS BODY DAILY BUZZKILL PENISES

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