Question:
Is gene testing available yet for BPD treatment?
Dr. Heller's Answer:
No, it's not. Amazing advances
have developed in brain DNA research, but
we're not at that point yet. The
"serotonin transporter gene" seems
to be the one that could have some
relevance with the BPD. The S
(or short) allele is associated
with reduced resilience to life's stressors.
The most interesting gene effect in BPD
treatment has to do with those of Asian
descent who need Tegretol
(carbamazepine). Those individuals
need to have an "HLA-B*1502 allele"
checked prior to treatment as those
individuals are at a 10 fold increased
risk of a potentially fatal rashes such
as "toxic epidermal necrolysis" and
"Stevens-Johnson Syndrome." While
the absolute risk is small, there is a
definitely higher risk in individuals with
that gene.
Even with that gene, if a borderline is
out of control or suicidal, the risk of
trying Tegretol (carbamazepine) may be worth
the benefit. The FDA has not
prohibited the use of Tegretol
(carbamazepine) in these patients, but has
stated that "patients testing positive
(for that gene) should not be treated with
carbamazepine unless benefit clearly outweighs
the risk." The BPD has a 10%
completed suicide risk, so there may be
situations where these risks may need to be
balanced and weighed.
|
Video DVDs now available!
