Mental health treatment is steadily on the rise in the United States. In 2011 a JAMA Internal Medicine report found that 1 in 10 Americans had taken medications to help with mood, anxiety or thought process. In 2013 it was estimated that approximately 1 in 6 Americans had taken similar medications. Seven years later and in the midst of an international pandemic, we can only surmise that the number of individuals requiring some type of psychotropic medication has increased more significantly.
Unfortunately, many individuals do not respond to these medications as expected. Some people suffer significant adverse drug reactions (ADRs), others experience the opposite of the intended effect (paradoxical reaction), and still others experience no change. ADRs are not only scary for some people, they can actually be fatal. In 1994, ADRs were one of the leading causes of hospitalization and death in the United States with 2.2 million serious ADRs reported and 100,000 deaths (TP, A et al, 2009).
As a health care provider, I can share that I often see individuals that are on a number of psychotropic medications and complain to me about continued or worsened emotional distress, despite medications. Often, their stories are similar: they were started on one anti-depressant, then had another medication added to treat side effects of the first medication, then had a third medication added because they either slept too much or could not fall asleep, and on and on.
Treating individuals with emotional distress is not an easy, 10 minute in and out clinic visit. It requires time to evaluate. Emotional distress is a symptom of an underlying condition. That condition can be nutrient related (for example, Vitamin D deficiency can cause depression), it can be hormonal (low progesterone or testosterone can cause anxiety), it can be due to neurotransmitter imbalance (low serotonin causes depression). Mood and thought changes can even be attributed to diet, altered gut microbiome, heavy metal toxicity or chronic environmental exposures -- even mold or Lyme's disease. There are many varied possible causes.
How a patient is treated depends on the severity of symptoms, what has been tried in the past, support system, lifestyle, financial status and patient preference. As a Functional Medicine provider, it is always my goal to help get to the root cause. While we are exploring imbalances and developing appropriate lifestyle changes, sometimes people need something to get them through until we have more answers. It is also important to understand each individual's specific enzyme pathways, in order to understand how they will be affected by herbs and medications. This is where genetic testing can have a profound positive impact on developing an individualized treatment plan.
The ability to decode the genome has allowed us to understand how genetics influences the biochemical processes in our body. Pharmacogenomics is the study of how our genes effect our body's ability to process and break down medications. For patients, the benefits are significant - the test only has to be completed once in a lifetime (genes do not change), the risk of taking a medication that can cause a life threatening ADR is greatly reduced, the likelihood of starting on the right medication the first time is significantly increased.
For clinicians, pharmagenomic testing provides significant insight and guidance for prescribing the right treatment the first time. It takes the guess work out of determining which class of medications is the safest to use for initiation of therapy. Additionally, the report can be used as a reference document for both the clinician and patient to be on the same page.
Pharmacogenomic testing is a great tool for the Functional Medicine provider to help guide treatment options for medications. For my own practice, I have found it most helpful when I see someone who is on multiple medications and we are trying to wean off one at a time. Generally, I see people who are frustrated with their care and do not know where to turn. As a clinician, it is challenging to know which medications to eliminate first while keeping an individual safe and stable emotionally. Once we determine genetics, we invariably find that an individual is taking one or several medications that they are genetically not breaking down properly. We start by removing those medications first, and stay in close touch regarding emotional response.
Emotional health is influenced by many factors. A well rounded, multi-faceted approach can take time, but ultimately can be the most successful. Part of that approach includes pharmacogenomic testing, along with an appropriate diet and lifestyle assessment and counseling where indicated. Personalized medicine has taken on a whole new meaning with the advent of genetic testing. For all individuals who are taking psychotropic medication and questioning how well they are responding, pharmacogenomic testing may be a great tool for you and your provider to utilize.
Gina Ditta-Donahue is a certified Family Nurse Practitioner and Anti-Aging Medicine provider. She is the author of "Josh's Smiley Faces: A Story About Anger," a children's book aimed at helping young children and their parents navigate anger management and build adaptive life skills. She is also co-owner of Elevate Functional Medicine.
T P, A., M, S. S., Jose, A., Chandran, L., & Zachariah, S. M. (2009).
Pharmacogenomics: the right drug to the right person. Journal of clinical medicine research, 1(4), 191–194. https://doi.org/10.4021/jocmr2009.08.1255