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The Surprising Ways Your Ethnicity Can Affect Mental Health Treatment

Your daughter has taken multiple prescription medications to control her anxiety disorder, but they’ve caused side effects like nausea and vomiting. Worse, none have helped her anxiety. Is this a normal response to medications, or could her genetics be influencing this response?

The answer could be both.

The way you respond to a medication is affected by many factors, including but not limited to your age, health history, environment, and unique genetic profile. Pharmacogenetics (PGx) examines the relationship between drug response and your inherited traits, or the “instructions” coded in your DNA.

Your exact genetic makeup is your own, but individuals who can trace their ancestry to particular ethnic groups or geographic regions often have common genetic variations. What that means: Your ethnicity may have surprising effects on how mental health medications work for you.

“We still do not fully understand why some ethnicities may be affected by a particular genetic variant,” said Tori Hoffman, PharmD, RPh, a Medical Science Liaison at Genomind. But researchers know that understanding genetic differences in how people break down or may respond to mental health medications can provide powerful information to a prescribing clinician.

Here are two ways your ethnicity may affect mental health treatment, plus how you can personalize your medication plan.

CYP2C19*35 Variant

This variant almost exclusively impacts people of African ancestry. Normally, this gene variant travels along with a partner variant called *2, but in those of African ancestry, it can exist by itself. Historically, few consumer genetic panels have tested for the *35 variant because the assumption was that testing for the *2 variant alone was sufficient.

How Does It Affect Mental Health Treatment?

An individual who carries the *35 variant in the CYP2C19 gene will have markedly reduced function of an enzyme that is involved in the metabolism, or breakdown, of several medications. That means more of the medication will stay in the body, which can lead to side effects.

Someone who is a “CYP2C19 poor metabolizer” may experience side effects with common selective serotonin reuptake inhibitors (SSRIs), including:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Sertraline (Zoloft)

The *35 variant can also affect how the body handles other types of antidepressants and anti-anxiety drugs.

What Can Clinicians Do?

If clinicians know a patient has the *35 variant, they can use a lower starting dose for select SSRIs, as recommended by the Clinical Pharmacogenetics Implementation Consortium. Or they can choose an alternative medication.

HLA-B*15:02 Variant

This variant is found in 4 to 7 percent of people of East, South, or Central Asian or Oceanian ancestry. It is rarely found in people of African or Middle Eastern ancestry.

How Does It Affect Mental Health Treatment?

An individual who carries the *15:02 variant in the HLA-B gene is at higher risk of a serious adverse skin reaction to carbamazepine (Tegretol), which is often prescribed to treat bipolar disorder.

Seema Patel, PharmD, BCPP, a Medical Science Liaison at Genomind and a person of South Asian ancestry, had no idea she carried the variant until she had her own PGx test done. “If I had ever taken certain medications that are affected by this variant, like Tegretol, I would have risked my life, since they can cause serious skin reactions that may require hospitalization or even be fatal,” she said.

What Can Clinicians Do?

For patients of Asian ancestry, clinicians will typically order a test to check for this variant before prescribing carbamazepine.

How to Personalize Your Mental Health Treatment

Wondering if you have these ethnicity-related variants or other genetic factors that can affect how your body works with mental health medications?

Pharmacogenetic testing with Genomind looks at 24 genes related to mental health treatment. It provides guidance across 10+ mental health conditions and 130+ medications to help your clinician determine:

  • Which medications will likely be the most effective
  • Which medications may have side effects
  • How you metabolize medications for personalized dosing guidance

When you receive your Genomind report, you may notice it highlights specific recommendations for various ethnic groups. It’s another way to help you and your clinician better understand your unique makeup.

For example, most PGx tests don’t look for the CYP2C19*35 variant. But when recent scientific guidelines recommended adding it, Genomind did. As a result, more than 100 individuals with this variation learned about it with the Genomind test—and their clinicians were able to make more informed decisions about medication.

The Genomind test requires a prescription. Learn how to get the Genomind test here.

Does Your Medication Work for You?

Get a lifetime of mental health treatment guidance. Genomind’s leading pharmacogenetic test was designed to help your clinician personalize your treatment plan based on your genetic profile. Get started today.

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