If you have recently had an appointment with me you have probably heard something about a new trend in the mental health field: the use of pharmacogenomics. Pharmacogenomics is the study of how a person’s genes affect their response to medications, and this trend has resulted in the creation of several lab tests which targets those genes most relevant to mental health and mental health pharmacology. After a few months of prescribing these tests to my clients, they have made quite an impression upon me.
My only problem is that I am having a little difficulty talking to clients about the benefits of these tests without sounding like an infomercial. So I thought I would start off by making it very clear: I have no financial interest in a pharmacogenetic company nor do I receive any financial incentive for the prescription of these tests. (I actually regret not having a financial interest in these companies as I might be able to retire a little early)***
Pharmacogenomic tests have become a big deal, and their prescription practically standard in my practice because:
1) they highlight the meaningful differences between all of us in how our genetics contribute to our mental wellness
2) they help filter out potential medications that might be less effective and more likely to cause uncomfortable side effects
3) and they link genetic variances to specific over-the-counter and complementary supplements that may enhance your response to medication or stack the deck in your favor if you want to address mental health concerns without medication
We really ARE all different
The pharmacogenomic test results highlight meaningful differences in how our genetics can influence our mental health. Some examples:
- variability in the genes that code for a neuron-cell’s ion channels can allow electrically charged ions to leak across the cell membrane and make the neuron less stable—a possible contributor to the experience of anxiety
- a genetic variance that decreases the effectiveness of the enzyme (catalyst) that transforms folic acid (a vitamin) into one of the ingredients in our neurotransmitters (e.g., serotonin, norepinephrine and dopamine)—which can result in a deficiency in some neurotransmitters
Regardless of the specific genetic variance, it has been comforting to many clients to learn that there is some biological/genetic contributor to how they experience the world. This has been information that has greatly helped underscore the very valid sentiment of “It’s not your fault.”
More precise medication prescription
When it comes to mental health prescription, fitting your symptoms to one of the many available medications without getting unwanted side effects can resemble more art than science. At times my initial medication recommendation could approximate a very thoughtful throw of a dart towards a pharmacological dartboard. But with pharmacogenomic test results, the size of the dartboard can be much smaller.
The information that these tests produce does not tell you which medication will work, but it can tell you if there are glaring genetic reasons why a particular medication may be ineffective or likely produce uncomfortable side effects.
- the results provide insight into your metabolic system so we will know if a medication is likely to be processed out of your body too quickly to be effective or in a way that will likely lead to side effects
- some medications target specific biological features (e.g., a certain type of neurotransmitter receptor) that may be more or less abundant depending on your genetic profile—if there isn’t enough targets, then don’t try the medicine
Supplements to support mental wellness
An internet search for over-the-counter solutions to mental health issues will provide a long list of supplements. Certainly, not all of them will be effective and some may even be dangerous. Many mental health prescribers have been hesitant to recommend any specific supplement because much of the research, although encouraging, does not show a large enough effect on symptoms to justify a formal “medical recommendation.”
Enter pharmacogenomics whose test results can suggest several complementary and alternative supplements that may be helpful to your mental wellness depending on your genetic profile.
- if you are someone whose enzymes do not efficiently transform folic acid into neurotransmitter ingredients, then your provider may recommend supplementing your diet with L-methylfolate (found without prescription at a health food store or online)
- if your genetic profile revels ion channels that promote an instability of neurons, your provider may recommend omega-3 fatty acid supplements to help “fatten” up your cell membranes to decrease the amount of ions leaking across
Pharmacogenomics is the future
The results are in and many of my clients are experiencing a reduction in symptoms and an improved quality of life through the help of pharmacogenomic tests. Several clients have shared that their new prescription regimen has given them a “new normal” that they have not been able to achieve with their history of mental health prescription medication. Hopefully these tests will become more mainstream across the mental health community, and I also wouldn’t mind seeing some discussion about whether these tests can be useful in children or high-risk populations to see if early intervention can prevent the development of more severe symptoms later in life.
There are several pharmacogenomic tests available. Be sure to ask your mental health provider about them, as you might just be one cotton-swab of your cheek away from getting results that could dramatically improve your response to mental health medications and how you feel every day.
*** Update October 7, 2016 – As many of my colleagues and my current clients already know, I have a small “crush” on one particular company that provides a genetic test that specifically addresses the needs of mental health consumers and prescribers. This company is GenoMind, and as of September of this year I have received compensation from them for teaching other providers about the test and why I think it’s such a big deal. Although GenoMind pays me to teach people about their test, I remain financially disinterested in GenoMind the company, and I am also not compensated in any way for the prescription of individual tests.