- 23andMe Co-Founder and CEO Anne Wojcicki
- Steve Jennings/Getty Images for TechCrunch
- Anne Wojcicki, the CEO and founder of Silicon Valley’s most popular genetics testing startup, 23andMe, said this week that she hopes the company expands its current health offering lineup.
- 23andMe, which made headlines recently on the heels of a new $300-million partnership with drug giant GlaxoSmithKline, currently offers health screenings for some of the genes involved in breast cancer, Alzheimer’s, and Parkinson’s.
- On Tuesday, Wojcicki said she hopes to add a new health offering that looks at how you process medications including those for depression.
- Albertsons pharmacies and gene testing startup Color Genomics currently offer that kind of test for $250-$750, but many scientists say it’s not worth the money.
Anne Wojcicki, the CEO and founder of popular Silicon Valley gene testing company 23andMe, doesn’t feel like the company is currently offering what she called a “complete product.”
That’s because the current gene testing kit – which includes health screenings for some of the genes involved in Alzheimer’s, Parkinson’s, and breast cancer – does not include a test that looks at how you process medications including those for depression.
Those DNA tests, which assess genes involved in the break down of antidepressants in the body, are currently being offered by psychiatrists and Albertsons pharmacists in three major cities at a hefty price tag of $750. Just last month, another Silicon Valley genetics testing startup called Color Genomics began offering the test as part of its $250 kits.
And on Tuesday at a conference organized by Rock Health, one of Silicon Valley’s premier health-tech funding groups, Wojcicki said she hoped her company could include that kind of test in its product lineup soon.
But many scientists feel the tests don’t offer a clear benefit to people and in some cases are not worth the money. Among other issues, the tests may give conflicting results to the same patient for the same medication and don’t tell providers which specific medication is best, according to experts.
‘When we can bring pharmacogenomics back, then we have a complete product back’
- Lydia Ramsey/Business Insider
In the early days of 23andMe, the company included a test for depression medications in its lineup of health offerings, Wojcicki said. But in 2013, the Food and Drug Administration forced the company to stop selling those products and get federal approval on the grounds that the tests could be misinterpreted as health advice. The company was allowed to continue selling the genealogy component of its kit, which looks at ancestry.
Last year, the FDA gave the company the green light to again sell some of its health screenings. On the heels of that decision, 23andMe rolled out a limited selection of some of its original products. The most recent addition, unveiled in March, is a test for some of the genes involved in the risk of developing breast cancer, also known as BRCA genes.
Now, the company is only missing one of those original health products, Wojcicki said: a test for depression medications, also called pharmacogenomics.
“The only one we don’t have back yet is pharmacogenomics. We used to have that and we’d like to have that one come back,” Wojcicki said on Tuesday at a panel discussion at the Rock Health Summit in San Francisco.
“When we can bring pharmacogenomics back, then we have a complete product back,” she said.
It remains to be seen how the company would roll out such a test. Because 23andMe sells its tests directly to people (they can be purchased online and at a selection of drug stores), it would need to get FDA approval before selling an additional health product. The test could be incorporated into the existing health lineup, which currently includes tests for Alzheimer’s, Parkinson’s, and breast cancer for $199, or it could be sold as a stand-alone test.
Color Genomics chose to incorporate its new pharmacogenomics product into its existing $250 test. Unlike 23andMe, which sells its services directly to consumers, Color requires people to order their tests through a medical provider. In addition, the company mandates talking with a professional genetics counselor and a clinical pharmacist to avoid potentially dangerous misinterpretations of the results.
Genomind and Assurex, the two companies who offer a standalone pharmacogenomics product, sell the test through psychiatrists and some pharmacists for $750.
Wojcicki did not provide further details on how much the test – should the company ultimately choose to offer it – would cost or when it would be available. A company representative also declined to offer Business Insider more information about the test. But Wojcicki said she saw the pharmacogenomics service as part of the company’s overall mission to help empower customers with more data about themselves and prevent negative health outcomes when possible.
“I think one thing genetics can do is help prevent a lot of early deaths,” Wojcicki said.
- Flickr/Jane Rahman
- Several companies make DNA tests that claim to tell you how well you’ll respond to certain antidepressants based on your genetic profile.
- Two personalized medicine companies – Assurex and Genomind – offer some of the most popular tests and work with physicians and pharmacists to provide them to patients.
- A chain of Albertsons pharmacies in Chicago, Philadelphia, and Boise is running a pilot program in which pharmacists can offer the Genomind test.
- Silicon Valley genetics testing startup Color Genomics recently began offering a similar test as part of its services.
- The costs of the tests range from $250 to $750, but some scientists say it’s not worth the money.
Around the time that 26-year-old Courtney Luk got in line at the pharmacy to pick up her 25th depression medication, she decided she’d had enough.
Over the previous two years, Luk had been prescribed everything from Klonopin to Xanax to treat the anxiety and depression she’d experienced since adolescence. Nothing seemed to do the trick. One medication would make her feel numb; others seemed to make her symptoms worse.
Then a psychiatrist suggested she try a genetic test that could provide guidance about which drug Luk should try next. They swabbed the inside of Luk’s cheek for a spit sample and sent it off to get tested.
Using DNA testing to determine how well a given depression medication will work with a patient’s genetic makeup is becoming a popular approach. More than 750,000 people have taken one such test, called GeneSight, which is made by personalized medicine company Assurex, according to its website. A network of 28 Albertsons pharmacies offers a similar test made by a company called Genomind as part of a pilot program. And just last month, Silicon Valley genetics testing startup Color Genomics began offering a test as part of its $250 kits.
But some scientists say the tests have limited utility.
That’s because they doesn’t tell providers which specific medication is best to prescribe patients, according to Alan Schatzberg, a Stanford University psychiatrist and the director of the Stanford Mood Disorders Center. And Cristina Cusin, a Harvard psychiatrist, said the test won’t give helpful results to patients who take more than one medication.
Plus, the tests may give conflicting results to the same patient for the same medication, according to a peer-reviewed analysis of four different gene tests published this summer.
A pricey test with a lofty goal
- Getty Images/William Thomas Cain
Since adolescence, Luk had experienced debilitating anxiety that sometimes turned into panic attacks, along with mood swings and depression that sometimes led her to contemplate taking her own life. Despite trying more than two dozen different medications, Luk and her psychiatrists had yet to come up with a combination of drugs that significantly lifted her mood without contributing to her anxiety.
Luk had heard of genetics tests for antidepressants before, but previously declined to take one since she couldn’t afford the $750 price tag.
But when a psychiatrist suggested a test she could get for free through insurance, a kit from Genomind called the Genecept Assay, Luk said yes. The test appealed to her as a potential way to eliminate the trial-and-error process of starting a new drug and waiting – sometimes up to six weeks, the standard for most antidepressants – to see if it worked.
“I don’t feel like my medications right now are working optimally, and I was hoping to learn if there’s a cocktail of medications that would do that,” Luk said.
Her psychiatrist told her the test might show them what to do next. Perhaps they’d learn that one medication wasn’t right for her body and could be replaced with a different drug. But when the results came in, they were murkier than Luk anticipated.
Her report listed all the antidepressants she’d taken along with several she’d yet to try. Each got a colored check mark: red checks suggested Luk would likely have negative reactions to a drug, green checks suggested no negative reactions, and orange checks indicated something in between.
Next to a popular antidepressant called Celexa, for example, Luk’s test showed an orange check mark and said, “increased risk for adverse events or poor response.” That meant that because of the way her body processed the drug, Luk was more likely than the average person to experience negative side effects or see no positive results.
Sure enough, Luk recalled that when she’d taken Celexa several years earlier, she had experienced painful bruising across her arms and legs.
But another drug Luk had recently begun taking, called Topamax, carried a green check and said “use as directed – no known gene-drug interactions.” Despite taking that medication for several weeks, however, Luk said she hadn’t experienced any change in her symptoms.
So she went back to trial and error.
Daniel Dowd, Genomind’s vice president of medical affairs, acknowledged that some patients may read too much into the test.
“I think patients do tend to think, ‘OK, this is going say exactly what this specific drug is going to do for me,’ and that’s not what this test is,” Dowd told Business Insider. “Like any other branch of medicine, [the test] provides an estimation of risk.”
Genomind funded a 2018 study of its test that analyzed patient spending in the six-month period following use of the test. The authors – one of whom sits on Genomind’s scientific advisory board – compared roughly 800 people with mood and anxiety disorders who took the test with nearly 3,000 people who didn’t take it. They found that people who took the test spent nearly $2,000 less on healthcare on average, mostly because they visited ERs and hospitals less frequently in the months following the test than people who didn’t take it.
The researchers wrote that it could represent “a promising strategy to reduce costs” in people with depression and anxiety.
To Dowd, the finding was a big endorsement of the test.
“If we can get this test embedded in the healthcare record, that could mean a big cost savings,” he said.
Who the test may – and may not – help
Once you swallow a pill, various genes control how your body will break it down. One gene in particular, called CYP2D6, is one of the most closely studied. Some people have faulty or abnormal copies of that gene, meaning they don’t process drugs like antidepressants as they should. That increases the chances that someone could have an adverse reaction like bruising or not respond to a medication at all.
The gene tests are designed to assess whether a patient is likely to have a negative outcome on any common antidepressants. In theory, that would help patients and their providers narrow down the list of potential medications to try.
“In these cases, I think there is clear evidence” for using a gene test, Michelle Whirl-Carrillo, a senior research scientist at the Stanford University School of Medicine, told the author of an article published by the Journal of the American Medical Association (JAMA).
But Schatzberg, the Stanford psychiatrist, said a narrower list is not what his patients need.
“What’s really needed is a test that says, ‘You have this profile, these are the two drugs you need to use.’ That’s what’s missing,” he said.
Instead, the tests merely tell him if someone’s body doesn’t process a drug properly – a conclusion they’d reach anyway after trial and error.
“I don’t necessarily need to know up front if a person is a poor drug metabolizer. I need to know which specific drug to use where I will get the positive effect with less side effect burden,” Schatzberg said. “These tests don’t do that.”
Cusin, the Harvard psychiatrist, specializes in treating people with severe depression. She agreed with Schatzberg.
“I don’t think psychiatrists get much information about the costs and benefits or much predictive value for this type of test,” she said.
Cusin added that she doesn’t think the test helps in cases where people are taking multiple medications or when patients have a history of failing to respond to medications. Plus, she said, a recent study made her hesitant to use the tests in her own practice.
That study found major inconsistencies among four different gene tests (including Genomind’s). In roughly one out of five cases, the authors said, different tests gave conflicting advice to the same patient.
“The level of disagreement in medication recommendations … indicates that these tests cannot be assumed to be equivalent or interchangeable,” the researchers wrote.
‘I jumped on it because I was tired of trial and error’
Unlike Luk, Allyson Byers, a 27-year-old in Los Angeles, said taking a genetic test saved her time in the quest to find the right medication.
Byers took Assurex’s GeneSight test after trying several drugs for her depression.
“I jumped on it because I was tired of trial and error,” she told Business Insider.
Byers said she paid $60 for the test after talking with her therapist and an Assurex representative (though she initially received a bill for several hundred dollars).
Her results weren’t perfect. Byers had been taking the antidepressant Zoloft for nine months, but she experienced several negative side effects, including weight gain. On the Assurex test, however, Zoloft was green-lit.
“When the results came back, I was questioning myself and thinking, ‘Did I make that all up? Did I really gain weight?’”
But the test also suggested another medication called Pristiq that Byers had not previously taken, she said. So Byers’ therapist suggested they try that instead of Zoloft. Several weeks later, Byers said she felt better – and thanked the test for helping her find a different medication.
“I’ve had to go up in dose a couple times, but I feel like I’ve finally found the right dose,” she said. For her, the test was “just another tool to help narrow things down.”
Coming to a pharmacy near you?
Increasingly, some patients are learning about genetics tests for antidepressants from their pharmacist instead of a psychiatrist.
In Chicago, Boise, and Philadelphia, 28 Albertsons drug stores are offering the Genomind test, according to Kimberly Hecht, a patient care services coordinator with Albertsons who leads the project.
She told Business Insider that mental health became a focus at the pharmacies she oversees when they began offering medications for drug addiction. Plus, because Albertsons’ pharmacies are open longer and on more days of the week than others nearby, they sometimes function as a default mental health provider, Hecht said.
“It just made sense with what we were offering and also because of our position in the community,” Jennifer Rapley, a marketing manager with Albertsons who works closely with Hecht, told Business Insider.
The project is currently in a pilot phase, but Genomind hopes to eventually offer its gene test in all 1,760 Albertsons-owned pharmacies throughout the country, JAMA reported this month.
But some components of the Albertsons program – such as how pharmacists determine whether a patient is a good candidate for the test and how it evaluates whether the results are effective – remain hazy.
For example, a patient does not have to have a history of using antidepressants to be offered the test, Hecht said.
“Typically it’s going to be patients who’ve tried a couple different things and it’s not working, but we kind of leave it up to our pharmacists’ professional judgment,” she said.
That makes Schatzberg wary.
“I think it presents real problems,” he said. “It’s practicing a level of medicine and offering a test where it’s not clear whether and how it should be used. It’s hard for me to believe that’s a good idea.”
The future of genetic testing for depression
Last month, Silicon Valley genetics testing startup Color Genomics began offering a test for antidepressants as a component of its DNA tests, which screen for gene variations linked to cancer and heart disease. Color’s service includes a professional genetics counselor as well as a clinical pharmacist who walk a patient through their results.
Othman Laraki, the company’s founder and CEO, told Business Insider that he sees the new test in a similar light to Color’s cancer test, which the company began offering in 2013.
“Like we saw with cancer, it’s definitely a moving target, it’s definitely still early, and there’s still a lot of uncertainty,” Laraki said. “But there’s enough support and enough scientific validity where it makes us feel comfortable enough to offer it.”
Hecht, the Albertsons coordinator, agreed.
“These types of tests really are the future and have the potential to really help people,” she said.
But for some patients, that future may not have arrived yet.
“After 25 different drugs, I may just be one of those people whose bodies doesn’t respond to medication,” Luk said. “In the end, it’s still trial and error, but it’s a little bit more of a targeted trial and error – a little bit more of an educated guess.”
- In January, an author wrote a series of stories in outlets including The Guardian and Huffington Post claiming that antidepressants don’t work.
- A large new review of studies backs up what scientists have been saying for years: that in fact, the drugs do help.
- The study was written by a team of 18 specialists and looked at more than 500 trials comprising more than 100,000 people. All 21 of the drugs they studied were more effective than a placebo at reducing the symptoms of depression.
Coffee causes cancer. Eggs give you high cholesterol. Lexapro is a scam.
Health advice these days feels like a game of ping-pong, and the accepted wisdom on antidepressants like Lexapro – one of the most popular drugs used to treat depression – is no exception to that mixed messaging.
In January, writer Johann Hari published a series of personal stories in outlets like The Guardian and the Huffington Post in which he claimed that antidepressant medications didn’t help him because “the whole idea that depression is caused by a ‘chemically imbalanced’ brain is wrong.”
Fortunately, a large new review of 500 studies comprising more than 100,000 people and published this week in the medical journal The Lancet, backs up what many experts in the fields of psychiatry and neuroscience have been saying for decades: antidepressants do work.
The review found that the drugs can be powerful tools in the fight against depression, which today remains the leading cause of disability and a major cause of suicide worldwide.
Written by a team of 18 medical doctors and specialists in Europe and England and funded by the UK’s Department of Health, the review concluded that all of the 21 antidepressant drugs they studied worked better at treating depression than a placebo.
In direct comparisons of some of the drugs, small differences in the results appeared, with the research suggesting that some medicines like escitalopram (frequently sold under brand-name Lexapro) worked slightly better than drugs like fluoxetine (sold under brand-name Prozac).
- Darren Staples / Reuters
Still, antidepressants are not magic tricks.
Evidence suggests that for as many as 78% of people, simply taking a pill does not completely erase depression’s most insidious symptoms, which can include things like isolating oneself, having disturbing impulses to self-harm, or being so self-critical that it interferes with daily life.
A smaller percentage of people don’t respond to medications at all, a troublesome phenomenon known as treatment-resistant depression that remains one of the hardest types of the illness to address.
But for those whose symptoms do subside on antidepressants, they can be a powerful component of a larger treatment plan that might include things like therapy, group counseling, and exercise.
These other parts of treatment plans should not be discounted, as some studies suggest that the right forms may be just as powerful, if not more so, than medications. Unfortunately, therapy also tends to be expensive and time consuming, which makes it inaccessible to people who are working multiple jobs or can’t afford it.
Also, while most antidepressants work better than a placebo, it’s still somewhat unclear how much better than a placebo they function. For the latest review, the researchers found evidence that some medications ranged from being roughly a third more effective to more than twice as effective as a placebo – a fairly wide range. This means that some people’s symptoms may dramatically clear after a few weeks on the right drug while other people get only slight relief.
However, the main takeaway from the latest paper appears to be that for many people, antidepressants can be a helpful part of a broader approach to treatment – and in some cases, they provide powerful relief that isn’t available otherwise.