A Test to Help Choose an Antidepressant?

Bret S. Stetka, MD; Evian Gordon, MD, PhD

Disclosures

April 09, 2015

Editor's Note: The US Food and Drug Administration (FDA) is currently evaluating a test to predict which antidepressant might be appropriate for a particular patient. The test was developed by Brain Resource, Ltd (San Francisco, California) and purportedly could help personalize the management of depression. Medscape recently spoke with Evian Gordon, MD, PhD, founder and CEO of Brain Resource Ltd and adjunct associate professor at the University of Sydney Medical School in New South Wales, Australia, about this test and the future of personalized psychiatry.

Medscape: How does your newly developed test predict the efficacy of antidepressant treatment?

Dr Gordon: The Depression Prediction Test is the first objective, personalized test of treatment prediction in psychiatry. It is a 40-minute online assessment of each patient's core cognitive and emotional capacities that predicts who is likely and not likely to respond to the three most commonly used antidepressants in the United States: escitalopram (Lexapro®), sertraline hydrochloride (Zoloft®), and venlafaxine (Effexor XR®).

Cognition assessment measures memory, attention, and planning using brief tasks; emotion is evaluated via the accuracy of face emotions; and feelings are indicated by the level of stress.

Medscape: Can you review the evidence supporting the test's accuracy? 

Dr Gordon: The study was the international Study to Predict Optimized Treatment (iSPOT) in Depression.[1] Cognition and emotion were assessed in 1000 patients (at 20 sites across the United States, Europe, and Australia) before and after 8 weeks of random allocation of each patient by a clinician to one of the three antidepressants. Forty thousand statistical analyses were done to determine the optimal algorithm that predicted who did and did not achieve "remission" (fewer than five symptoms) after 8 weeks of antidepressant medication.

Medscape: What is the test-taking experience like for patients?

Dr Gordon: The patient receives an ID code from their clinician (usually a primary care physician) to log onto the MyBrainSolutions.com clinical portal and take the online 40-minute test battery of engaging and challenging tasks. The clinician receives the test report within 2 minutes of their patient completing the test and can incorporate the "probability" results into their overall clinical judgment in deciding on a treatment program for each patient. 

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