Personalised Medicine

Personalised Medicine

Personalised medicine means profiting from your individual characteristics and physical condition in order to optimise our treatment and individually adjust it to you. Depression, e.g., can have various causes. The factors crucial for the success of depression therapy are accordingly diverse.

With our present-day level of knowledge, we have come much closer to our goal – a tailor-made depression therapy within the scope of the so-called personalised medicine. Various pieces of information help us to provide an individual profile of our patients and to adjust therapy accordingly. Thus, we can avoid unnecessary, i.e. ineffective, treatment and reduce undesirable side effects. This means more reliability for our patients and allows for a more effective treatment.

What about the efficacy of drugs? Which dosage of which drug is best for which patient?

Often, drugs are prescribed over a longer period of time until it becomes clear whether the patients profit from taking their medication at all. All drugs undergo several processing steps in the body before getting into the brain and exerting their therapeutic effect there. The first decomposition step takes place in the liver. After that, the renal function is important for washing the drugs out of the body. Since these decomposition processes vary in each patient with respect to efficacy and rate, we determine the individual concentration of particular drugs in the blood by means of therapeutic “drug monitoring” and are thus able to adjust the dosage to each patient’s individual rate of decomposition and processing.

More detailed genetic determination of individual liver enzymes (so-called CYP-proteins) indicate an individual degradation rate of certain drugs and potential interactions between various drugs and can therefore help to adjust an effective dosage.

The ABCB1-gene influences the functionality of a guardian molecule of the blood-brain-barrier which acts as a deciding point to allow the accessibility of certain antidepressants to their therapeutic place of destination – the brain. In particular single cases in the inpatient setting we determine variants of ABCB1 which serves in combination with further individual disorder patterns as recommendation basis for a personalized therapy.

The examples presented above allow us to perfectly design our drug treatment strategy with regard to a maximum therapeutic effect while at the same time keeping eventual side effects to a minimum.

What do our hormones reveal? Disturbed stress hormone regulation and antidepressant therapeutic success

Acute and chronic stress play a prominent role in triggering depressive episodes and various other mental disorders. This can lead to an imbalance of stress hormone regulation prior and during the acute phase of a disease– the brain loses control of its stress hormones. Depression as a disorder, as a result of chronic, long-lasting stress, leads to an overload of the organism. This, in turn, negatively influences the immune system, e.g., leading to an increased susceptibility to infections or an increased development of other diseases. Negative effects on the cardiovascular system are caused by development of high blood pressure, visceral adiposity (abdominal fat, fatty degeneration of internal organs) and diabetes. In addition, we observe negative impacts on the brain, culminating in atrophy of the hippocampal brain area, accompanied by loss of concentration, memory and learning.

With the so-called „Dex/CRH test“, scientists from the Max Planck Institute of Psychiatry have developed a precise method to diagnose these disorders of stress hormone regulation. Interestingly, successful depression therapy leads to a process of normalization, as shown by reduction of the stress hormone cortisol in the Dex/CRH test. Therefore, the cortisol response in the Dex/CRH test is considered as a biomarker, i.e., as a predictor, for a successful antidepressant therapy. Current research at our institute shows that besides the stress hormone cortisol, also its metabolites and the measurable activity of certain genes can play a crucial role as indicators of stress regulation. An essential factor in this context are the dynamic alterations that give us information on the efficacy of treatment. By determining these blood parameters, we aim to fast-track a more reliable prediction of the success of our current therapeutic strategy.

What is revealed by a metabolic risk profile?

The continuously activated stress hormone system leads to suppression of hormones of the pituitary gland, e.g., growth hormones, thyroid hormones or sex hormones. Deterioration of body composition goes along with an additional increase of the internal fat mass, reduction of muscle strength and development of osteoporosis. Through significant changes in behavior due to illness – such as unhealthy eating habits and lack of exercise –, mental disorders also lead to physical changes. The drugs used in therapy, which, depending on the individual disposition, lead to changes in basal energy rate, might as well contribute to this effect.

At our institute, there are state-of-the-art facilities enabling measurement of body composition and various metabolic parameters as well as a precise determination of the individual basal energy rate. We are able to individually determine the basal metabolic rate and the respective body composition (fat, water, muscles, bone density). With the options of our modern laboratory of clinical chemistry and our functional diagnostics, we generate an individual metabolic risk profile. In close cooperation with specialists in internal medicine, psychosomatics, psychiatrists and neurologists as well as benefitting from our on-site nutrition counselling, we develop individual concepts based on the basis of the information we have gained in order to counteract and individually treat poorly controlled metabolism, respectively. Thus, serious sequelae such as heart attacks, diabetes and strokes can be prevented in time.

What does your sleep reveal?

For depressed patients, sleep disorders are a frequent and nagging symptom. By means of nocturnal sleep studies in the sleep laboratory, characteristic alterations in sleep can be found, e.g., reduced restful sleep, frequently waking up during the night or disinhibited REM-sleep. Furthermore, various drugs can influence or even disturb sleep. These sleep disorders intensify the above-mentioned metabolic disorders and thus the risk to develop anteriosclerosis. Sleep studies in depressed patients aim to identify both alterations before therapy and effects of drugs. The results can contribute to personalized medicine by preventing side effects or predicting response to therapy.

What does your cognitive performance reveal?

Cognitive performance comprises the fields of perception, concentration, memory and executive functions (planning, problem solving, flexibility, monitoring and adjusting one’s actions) and therefore plays an important role in daily professional and private life. It is often affected in neurologic and mental disorders. Therefore, studying it with reliable and standardized procedures is an important part of an in-depth/comprehensive function diagnostics. Based on the profile of our results, we can generate an individual positive (good performances demonstrated) and negative (affected performances) performance record. This will also be the basis of an individual, tailor-made treatment in the form of a cognitive function training, depending on kind and severity of the cognitive loss of performance, e.g., for improvement of concentration.

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