Pharmacogenomics: A Breakthrough in Psychiatry

By Michael V. Genovese, M.D., J.D.
Chief Medical Officer

With the advancement of medicine and the multitude of available options, psychiatrists face numerous challenges in tailoring the appropriate course of individualized treatment for patients. Pharmacogenomics is the study of how a person’s individual DNA affects his or her response to medications and a scientific method of evaluating which medications a patient is likely to tolerate. The primary role of pharmacogenomics is to develop rational means to optimize drug therapy, with respect to the patient’s genotype, to ensure maximum efficacy with minimal adverse effects.

There are many factors involved in the decision-making process of administering medication such as efficacy, side effect profile, compliance, cost, family history, and the patient’s previous medication trials. Approximately 50% of patients do not respond to their initial medication treatment and up to 30% discontinue dueo intolerable side effects. Additionally, nearly 70% of patients are non-adherent to their prescribed medication schedule, with adverse reactions representing the most common cause. The statistics reveal the demand for an individualized approach to patient care and a treatment plan specific to the patient’s needs.

Pharmacogenomics provides an evidence-based approach to improving customized treatment outcomes. This personalized approach to medicine is safe and easy to accomplish. It minimizes patient frustration associated with a trial-and-error approach to pharmacology. Testing a patient is as simple as collecting cells from the inside of the cheek with a cotton swab. The cells are sent to a lab and results are generally available within a week. A detailed report provides patient-specific information regarding the genes that code for enzymes that are responsible for metabolizing medication and regulating its activity at the neuron.

Pharmacogenomics is a cutting-edge approach to behavioral health medicine and a breakthrough in the provision of comprehensive and tailored treatment plans. Information provided within the report is invaluable to the physician and the patient. The data is not dispositive, nor does it dictate that a certain medication must be administered. Rather, it provides information about how the body breaks down medications, the likelihood of side effects, and the potential for efficacy based upon the patient’s DNA. Thus we are able to more accurately predict benefit, while simultaneously validating previous suboptimal attempts. We can demonstrate that a patient’s inability to tolerate a prescribed medication was not weakness but genetic predisposition. With the support of pharmacogenomics data, physicians can more accurately dose a medication or confidently select an alternative. A “best guess” is no longer necessary. Now we are able to marry the art and science of medicine more successfully than we could in the past.

Research indicates that patients experience up to 70% greater improvement when their treatment was guided by pharmacogenomics testing. They appreciate the personalized data and are much more responsive to their customized treatment plans. Well-informed patients express a greater degree of confidence when entering into a treatment modality and, as a result, are better equipped to experience success in the healing process.

For over 30 years, Sierra Tucson has helped to navigate the path of hope and healing. Our patients come to us seeking health, wellbeing, and change. Our mission is to provide the highest quality of compassionate care and clinical excellence with the most comprehensive and individualized treatment plan specific to each patient. Therefore, we embrace and effectuate the changing landscape of neurobiology to function as successful advocates for our patients. The integration of pharmacogenomics complements and enhances the evidence-based treatments already offered at Sierra Tucson – where change begins.

Sources:

1. Hall-Flavin DK, Winner JG, Allen JD, Carhart JM, Proctor B, Snyder KA, Drews MS, Eisterhold LL, Geske J, Mrazek DA. Utility of integrated pharmacogenomic testing to support the treatment of major depressive disorder in a psychiatric outpatient setting. Pharmacogenetics and Genomics. 2013;23(10):535-548.
2. Hall-Flavin DK, Winner, JG, Allen JD, Jordan JJ, Nesheim RS, Snyder KA, Drews MS, Eisterhold LL, Biernacka JM, Mrazek DA. Using a pharmacogenomic algorithm to guide the treatment of depression. Transl Psychiatry. 2012;2:e 172.
3. Winner JG, Carhart JM, Altar CA, Allen JD, Dechairo BM. A prospective, randomized double-blind study assessing the clinical impact of integrated pharmacogenomic testing for major depressive disorder. Discovery Med. 2013;16(89): 219-227.
4. Winner JG, Allen JD, Altar CA, Spahic-Mihajlovic A. Psychiatric pharmacogenomics predicts health resource utilization of outpatients with anxiety and depression. Transl Psychiatry. 2013;3:e300. doi:10. 1038/tp.2013.2.