‘The burden of depression significantly impacts the patient, the healthcare system, and society at large.’
Life always has its ups and downs. But for some people with a genetic predisposition to depression and anxiety, the swings can be much harder to manage without the right combination of counseling and medication.
But which medication? Prescribing the right drug(s) to meet the unique needs of each person is a hit-or-miss proposition for almost any condition. But for depression, generally presenting with anxiety, the wrong combination can make a difficult situation far worse…even a route to suicide.
This is where pharmacogenomic (PGx) testing and analysis can make all the difference, reducing risks and speeding the patient’s return to a better quality of life.
Prevalence, cost and the impact of PGx
Depression affects approximately 16 million U.S. adults ages 15-44, with an increased risk of cardiovascular disease, all-cause mortality and of course reduced quality of life. It’s the leading cause of disability in the U.S., costing over $210 billion a year in direct and indirect healthcare dollars, lost workdays and productivity. In the process, it lowers a patient’s life expectancy by 7 to 11 years.
The bottom line from the study article link above: “Medication management guided by pharmacogenetics has been shown to increase therapeutic efficacy and improve symptoms in patients diagnosed with depression.”
So PGx has emerged as particularly promising in behavioral-health field. Today, drug-gene interaction evidence and an individual’s PGx test results can be used to accurately predict how well that person will likely respond to a particular drug. Since antidepressants take up to four weeks to begin working, the traditional method of guess-and-test can be an extremely time-consuming and inefficient process to treat depression. This lag in treatment efficacy places the patient at an increased risk of worsening depression and related adverse events.
Patients failing initial treatment with an antidepressant (and two-thirds do) will particularly benefit by having a PGx test performed and the results evaluated and discussed by a specialized clinical pharmacist. This will determine which medication will work best for them going forward. It also serves as a justification for billing insurance for such a test.
The evidence
The evidence is strong supporting the use of pharmacogenomic testing for tricyclic antidepressants, which have established actionable guidelines.
Among other research, a recent study sponsored by GeneSight (Myriad Genetics) showed that of 1,167 participants with treatment-resistant major depressive disorder (MDD), 30% were more likely to respond to treatment and 50% were more likely to achieve remission when their medication selection was guided by a psychotropic genetic test.
Medications showing PGx promise or that we’re studying
Amitriptyline (Elavil) and nortriptyline (Pamelor) — often prescribed for depression, anxiety and/or insomnia — are among the top 25 with the highest levels of clinical evidence and value supporting PGx testing prior to making or consider changing a prescribing decision.
Key PGx takeaways for treating depression and anxiety
- Counsel patients on what to expect with the antidepressant/antianxiety medication side-effect profile, time until benefit is seen, expected duration of therapy, etc.
- Suggest medication reminder apps, auto refill at the pharmacy, best time-of-day dosing strategies, ways to manage side effects, and establish a process for check-ins beginning a week after treatment begins.
- Consider having a pharmacogenomic test before starting certain medications to assess efficacy, risk profile and optimal dose
Behavioral health issues are some of the most impactful to your patients and the most challenging for you to treat. In future blogs, we’ll delve into other issues impacting your patients’ mental health, from ADHD and bipolar disorder to many others.
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Co-writer Bob Kropp, MD, MBA, CPHI, is a double-board-certified physician and Johns Hopkins-trained informaticist with 12 years of clinical practice and 20 years of managed care experience who consults with RxLive.
To learn more about RxLive pharmacogenomic testing and medication counseling services, contact us at kristen@rxlive.com.
You may also want to check out the following:
Saving $$S Through Pharmacogenomics
How Pharmacists And Pharmacogenomics Can Shorten Your Medication Prescribing ‘Odyssey’ And Improve Your Patients’ Health
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