In this section, I present some ad-hoc thoughts mainly on clinical management issues. There is no attempt to offer a comprehensive guide to Psychiaty. There is plenty of academic information readily available that provides such a service.
Some thoughts about the management of Depression and the use of genetic testing.
During my professional lifetime, Psychiatry has fundamentally remained a clinically descriptive specialty and in truth, special investigations have rarely helped in diagnosis. Somewhat ritually, we arrange haematology, urea & electrolytes, liver function tests and thyroid function; occasionally there are some incidental abnormalities.
There are a few drugs we use that require close monitoring but these are very much specialist use only. Apart from Lithium level and thyroid function, special pathological investigations have little practical use in the management of routine psychiatric disorders.
Treatment resistant depression is one of the most serious clinical situations referred to me and, I expect most other psychiatrists, because there is everything to play for. Get it right, recovery is the prize; if not, catastrophe.
Medication almost always has a critically important part to play with this group of patients. Invariably, they have tried two or more without success; until recently, I have had to impress on the patient and their families the critical importance of working through the medication in a methodical fashion, hoping that eventually an effective anti-depressant will be found for them.
Genetic testing does not improve the efficacy of medication of course; what it does is ensure that we don’t prescribe something that is going to be ineffective because of the patient’s biological make-up. It also can explain why previous prescriptions and treatment plans have not been helpful and under these circumstances, the patient finds it reassuring, because they now have an explanation for why they are no better.
Testing at the moment is relatively expensive, but whenever I have suggested it to the family, they have been happy to pay for it. Remarkably, the results have always informed prescribing which puts me in the fortunate position of only suggesting the medication to which they are likely to respond; and for the most part, they do.
I am confident that soon every patient, who is described as treatment resistant, will have genetic testing. It is a simple and effective investigation and in my experience, with every single patient, it has facilitated effective management, enhanced the instillation of hope and saved lives.