Let’s say you’ve been diagnosed with depression or anxiety. Your clinician recommended psychotherapy (a.k.a. talk therapy), so you set up appointments. They also recommended mental health medication, so you picked up your prescription from the pharmacy. All set, right?
Unfortunately, not necessarily. Though mental health medications, such as antidepressants, can be effective for depression or anxiety, they do not work for everyone in the same way. For some people, certain medications may not help relieve symptoms or may cause side effects like fatigue, sleep disturbances, or foggy thinking.
In these cases, treatment will rely heavily on trial and error. You’ll let your clinician know that you’re not getting enough relief from your symptoms, and your clinician will switch your medication and dosage until they find what works for you.
This process may be more common than you think. In fact, two out of three patients with depression don’t achieve complete relief following their first medication, according to a study in the American Journal of Psychiatry.
So, what’s going on?
Your genes could be at play. “A little variation in one of your genes can be enough to change the entire landscape of how you respond to medications,” says Greg Cooper, APRN-BC, a psychiatric nurse practitioner at Delaware Behavioral Health.
Here’s how PGx testing can help depression and anxiety treatment, plus a closer look at how four genes may affect how medications will—or won’t—work for you.
PGx Testing for Depression and Anxiety Treatment
From Cooper’s perspective, the traditional approach of trial and error can lead to delays in successful treatment, but PGx testing can provide valuable insight that can help him make personalized treatment decisions sooner.
“I’ve worked with patients who have suffered for years and maybe only improved a little bit after trying multiple medications,” Cooper says. “But understanding the genetics behind mental health can really help. It’s a great tool that helps us make strategic decisions. I’ve seen genetic testing change people’s lives.” (For example, check out Kristen’s experience in My Depression Story)
Cooper uses pharmacogenetic testing from Genomind, which looks at 24 genes related to mental health treatment. It provides guidance across 10+ mental health conditions and 130+ medications to help clinicians determine:
- Which medications may be more likely be effective
- Which medications may be less likely to have side effects
- How you metabolize medications for personalized dosing guidance
The Genomind PGx test requires a prescription. Learn more about it here.
Gene #1: MTHFR, an Essential Part of Neurotransmitter Production
The MTHFR genes create an enzyme that helps turn dietary folic acid and folate into L-methylfolate, Cooper explains. L-methylfolate is involved in the production of three key neurotransmitters: serotonin, norepinephrine, and dopamine. These neurotransmitters send signals to different parts of your brain, and together they help regulate your mood.
MTHFR variants can lead to significant reductions in the production of these neurotransmitters and theoretically increase the risk for various mental illnesses as well as decrease the effectiveness of psychiatric medications, according to Cooper. (MTHFR variants may also predispose you to low mood and energy – learn more about that here.)
The solution: If your Genomind PGx report shows that you have an MTHFR variant, your clinician may prescribe an L-methylfolate supplement. “That can allow your body to make the neurotransmitters it needs to function more effectively and possibly improve response to psychiatric medication,” Cooper says.
Gene #2: SLC6A4, Serotonin’s Personal Driver
The SLC6A4 gene creates a protein known as the serotonin transporter, which shuttles serotonin between your neurons (a.k.a. nerve cells).
If you have a variant of the SLC6A4 gene, it’ll affect the number of serotonin transporters you have, which ultimately affects your serotonin levels. “If you have certain variants, selective serotonin reuptake inhibitors (SSRIs) are less likely to work well for you—and more likely to cause adverse reactions,” Cooper says.
Here’s why: Common SSRIs include fluoxetine (Prozac), citalopram (Celexa), and paroxetine (Paxil), and they are often prescribed for depression and anxiety. They work by preventing the reuptake, or reabsorption, of serotonin in the brain—which increases serotonin levels and helps improve mood.
But if you have the SLC6A4 variant, you naturally have fewer serotonin transporters, so it already limits the reuptake of serotonin. Adding an SSRI could mean an overcorrection that leads to serotonin levels that are too high.
The solution: If your Genomind PGx report shows a variant of the SLC6A4 gene, your clinician may avoid putting you on SSRIs and instead prescribe a different type of medication.
(In addition to the implications for SSRI treatment, SLC6A4 variants can impact your immediate response to stress.)
Gene #3: BDNF, a Fertilizer for Neurons
This gene produces a protein known as brain-derived neurotrophic factor (BDNF). BDNF promotes nerve cell growth and maturation. It plays a part in learning, memory, and emotion.
“BDNF is like Miracle-Gro for your neurons,” Cooper says. “When your body doesn’t make enough BDNF, the health of your neurons suffers, and that’s connected with mental illness, including anxiety and depression.” Certain genetic variants that are associated with decreased BDNF activity may also influence your body’s response to stress.
The solution: If your Genomind PGx report shows a variation in your BDNF gene, your clinician can suggest a couple of options.
The first one is simple: exercise. “For lots of people with a BDNF variant, there’s an immediate improvement with regular exercise,” Cooper says. “They see decreased anxiety and fewer symptoms of depression.”
The second option your clinician may try, he adds, is a medication that’s associated with increased BDNF production. Find out how
Gene (Group) #4: CYP450 Group, the Cleanup Crew
The CYP450 group of genes regulates your liver, the organ responsible for metabolizing any toxins into harmless substances and releasing them from your body. “The liver filters about 90 percent of all the medications you take, breaking them down,” Cooper explains.
Your CYP450 genes regulate exactly how you metabolize the medications you take, and that makes a big difference in how effective the medications are. “If you’re an ultra-rapid metabolizer, you may have subtherapeutic blood levels of the medication and decreased effectiveness,” Cooper says. In other words, the medication may not stay in your body long enough to do its job.
“And if you’re a slow metabolizer, you may have higher than normal blood levels of the medication, which can cause side effects. Having this information is an amazing tool.”
The solution: Your Genomind PGx report will show how your body is likely to metabolize medications you take, which can help your clinician choose a dosage for maximum effectiveness.
Does Your Medication Work for You?
Genomind’s leading pharmacogenetic test was designed to help your clinician personalize your treatment plan based on your genetic profile. Get started today.