Pharmacogenomics for mental health

World Mental Health Day is coming up on October 10th – the purpose of which is to “raise awareness of mental health issues around the world and to mobilize efforts in support of mental health”. I figured this would be a good time to briefly describe how our MatchMyMeds™ pharmacogenomics test can help patients that require medications for mental health and psychiatric disorders including anxiety, depression, bipolar disorder, schizophrenia, attention deficit hyperactivity disorder (ADHD), and posttraumatic stress disorder (PTSD) among others.

First, a brief review – What is Pharmacogenomics? Pharmacogenomics (PGx) is a field of “personalized” or “precision” medicine, that aims to provide evidence-based drug and dosing recommendations based on a patient’s genetic make-up. PGx testing can be thought of as “drug-compatibility” testing which looks at how your liver metabolizes medications by analyzing the genes encoding a set of enzymes whose roles in drug metabolism have been very well established. Briefly (and over-simplifying), if a patient metabolizes a drug too quickly, the drug flushes through the patient’s system and is cleared out before it has a chance to accumulate to therapeutic levels – thus it just doesn’t work. Conversely, if a patient metabolizes a drug too slowly, it is not cleared out quickly enough, and especially if they take a second dose, and then a third dose, it can build up in their system to toxic levels which can put them at risk of unwanted side effects. Our MatchMyMeds™ test report includes very easy-to-read, clinically validated recommendations on which drugs are most likely to be effective, which ones to avoid, and which ones may require a dosage adjustment. This is a new tool that enables doctors to minimize trial-and-error and optimize outcomes by personalizing prescriptions based on each patient’s unique genetic makeup.

While PGx testing can be helpful for a broad array of therapeutic areas including cardiovascular, gastroenterology, rheumatology, pain, oncology and many others, perhaps the biggest impact area for PGx is for mental health – in fact, almost 40% of the medications covered by our MatchMyMeds™ test are for mental health issues. Many of these drugs are notoriously difficult to dose correctly, and prescribers will often anticipate that their patient will fail on the first attempt and have to come back for dose adjustments or to try alternative medications. This trial-and-error process can oftentimes be quite lengthy, especially for antidepressants and antianxiety medications which can take several weeks to either start to work or until you find out that it doesn’t work, another several weeks to detox or wash out the first drug, and then another several weeks to know if the second medication attempted will work. Only about one-third of depressed individuals are lucky enough to find a drug that works for them on the first attempt. The majority of patients must go through the trial-and-error process to get stabilized. Some may feel an improvement, but are unable to tolerate the side effects; others won’t receive any benefit at all. As a result, patients try multiple medications, varying doses, and even end up taking a combination of different drugs, and this process can take several months or even years. PGx testing can help predict which medications will work, and in many cases at what dose, the first time, thereby significantly minimizing this trial-and-error odyssey that patients often have to endure.

We recently hosted a webinar talking about the benefits of pharmacogenomics. Dr. Tim Cook, an internal medicine specialist and a practitioner of integrative medicine, spoke about a recent case study whereby his patient, a woman in her late twenties, was suffering with anxiety and depression for almost her entire life. She was taking citalopram (brand name Celexa), but was still not feeling well. After taking the MatchMyMeds™ test, it was confirmed that she is genetically incompatible with citalopram, and was switched to bupropion (brand name Wellbutrin), which her report indicated should work for her. Dr. Cook switched her meds and 6 weeks later she claimed that her levels of anxiety and depression were the lowest they’ve been in a decade. Dr. Cook discusses this case study in the video linked above (starts at about the 27:15 mark).

We love hearing stories such as these, so if you have any similar experiences, please don’t hesitate to reach out to us. Mental health issues are very common and these medications are very commonly prescribed. PGx testing can help minimize the trial-and-error prescribing process and get patients on the right medication at the right dose at the right time.