Pharmacogenomics testing reveals how individual genes influence which medications work in the body or have potential to cause side effects. Our general goal is to get to the root issues that might be causing depression or anxiety. We ackowledge that genetics do play a significant role in our individual mental health and in some cases our best efforts may still fall short in maximizing optimal mental health. In these cases a prescription medication may be recommended. Gene testing can help determine the safest and most successful medications to provide benefit. Understanding this, and using Pharmacogenomics information as part of a prescribing decision, can help achieve a more personalized solution for patients.
How Does the Testing Work?
Medical Diagnostic Laboratories, L.L.C. (MDL) offers a broad menu of Pharmacogenomics testing using state-of-the-art Next Generation Sequencing (NGS) technology. From a patient’s blood or buccal swab specimen, germline DNA is extracted for testing. This extracted germline DNA is used to prepare a library of short fragments that represent the genes of interest. This allows the patient’s DNA sequence to be read many times over, sometimes referred to as deep sequencing, so that we can detect, with a very high degree of confidence, all of the heritable DNA variants present. Finding these variants, and determining how they modify the function of the protein encoded in that gene, is the basis of Pharmacogenomics
Conditions such as depressive disorder, anxiety, and schizophrenia are long-term chronic problems where prescribing is notoriously difficult. Furthermore, there are well-recognized problems in changing a patient’s medication in these conditions. Genetic testing reports on the function of twenty-four genes affecting the function of sixty-two drugs, including Selective Serotonin Reuptake Inhibitors (SSRIs) as a general class.
Depressive and Major Depressive Disorder
This is a serious and debilitating disorder characterized by persistent and pervasive feelings of sadness and worthlessness that interfere with normal life. The diagnosis is by history rather than physiological testing. Consequently, therapeutic approaches have been varied and often, empirical. Pharmacogenomic analysis of ABCB1, ADRA2A, ANKK1, COMT, CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A5, DRD4, GABRA6, GABRP, GRIK4, HTR2A, HTR2C and MTHFR can help determine the necessary dose and/ or likely efficacy of many commonly-used drugs, including modern SSRIs such as citalopram.
Agitation and Anxiety
While related to depressive disorder and also treated with SSRIs, this condition and its related insomnia are considered distinct and are also treated with benzodiazepines (e.g., lorazepam), serotoninnorepinephrine reuptake inhibitors (e.g., venlafaxine), or general sedatives (e.g., midazolam). A consideration of the allelic nature of ADRA2A, COMT, CYP1A2, CYP2C19, CYP2D6, CYP3A4, CYP3A5, GABRA6, GABRP, HTR2A, and UGT1B15 may guide dosing and drug selection.
Choosing to take medication for support of mental health can be intimidating and unpredictable. Gene testing can help individuals focus on the best medications and avoid the most likely aggravating medications. Combined with your previous efforts to change the diet, detoxify, and support nutritional pathways, the right medication can add additional benefit when it follows your personal genetic makeup.