Depression in seniors: Can the genes choose the treatments?

Medicare has given its reimbursement blessing to a new genetic test that can help physicians treat seniors with depression. The Centers for Medicare & Medicaid Services (CMS) has approved local coverage determinations for GeneSight Psychotropic, a specialized genetic test developed by Assurex Health, Mason, Ohio. Local coverage determinations are used when national coverage codes are not available, and they often serve as bellwethers for growing acceptance of a treatment or protocol.

The test considers the patient’s unique genetic traits, then places U.S. Food and Drug Administration-approved medications for depression and other mental health conditions into color-coded categories: green for “use as directed,” yellow for “use with caution,” or red for “use with increased caution and with more frequent monitoring.” The test is the first pharmacogenomic test to receive coverage under Medicare, requiring no out-of-pocket costs for Medicare Part B beneficiaries.

The federal agency’s decision is being viewed by many as a tentative sign of welcome for the budding technologies that use genetic makeup to help create individually tailored drug treatment regimens.

Being able to pinpoint the best drug for any particular resident among many approved options—in other words, a drug chosen specifically for that resident based on genetics—could radically improve the effectiveness of the treatments and reduce the chances of unwanted drug reactions. Older adults, almost half of whom are taking more than four different medications per week, are more susceptible to adverse drug effects than younger adults, notes the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

“This is an important step forward for personalized medicine and a forward-looking appraisal by Medicare with regard to better diagnosis and treatment planning for mental health conditions,” said Bruce Quinn, MD, PhD, senior health policy advisor at FoleyHoag LLP and former medical director for the California Part B program, in an Assurex corporate announcement.

Nearly 15 percent of people aged more than 65 years—and almost half of all nursing home residents—have some form of depression, according to the Geriatric Mental Health Foundation (GMHF). Depressive tendencies can be exacerbated later in life by the onset of stressors such as the death of a life partner, lengthy hospitalizations, the loss of mobility, dementia, Parkinson’s disease or stroke. Depression is the number one complication of Parkinson’s disease, a fact that has gained greater awareness since the August suicide of comedian Robin Williams, in whom the disease recently had been diagnosed.

On the other side of the coin, depression can lead to sleep difficulties, social withdrawl, weight changes and other factors that can seriously affect a resident’s health and quality of life, the GMHF notes. Depression can be mistaken for dementia, because social isolation, poor concentration and interrupted sleep patterns could be signals of either condition. Research also  has suggested that depression and Alzheimer’s disease could somehow be related.

“In my experience, mood disorders in the older patient are more difficult to treat with inappropriate treatment leading to more emergency department visits and more psychiatric hospitalizations,” said Allan A. Anderson, MD, a specialist in geriatric psychiatry and past president of the American Association of Geriatric Psychiatry, in a press statement. “It is a relief to my patients and their families to know that a medication decision is more likely to be the right one, right away.”

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