Easing the Burden on Mental Health Patients With Precision Medicine

As more and more Australians are using antidepressants, or medications associated with mental illness, the time is right for a re-think on the approach to treatment of these conditions.

Eighty-nine Australians in every 1,000 are now prescribed some form of daily anti-depressant, but 10 years ago the rate was closer to 45 – near enough to a 100 percent increase, and more than enough cause for concern.

While the causes of this increase are numerous, and the center of many debates that don’t provide concrete resolutions about how to tackle the problem, one problem we can address is the lack of precision in depression treatment.

On average, statistics show that only 50 per cent of patients respond to their first anti-depressant treatment, making an already sensitive process difficult and time consuming.

There is also a degree of subjectivity that goes into mental health treatment, unlike many other medical areas that generally provide an accepted guideline for diagnosis and treatment that varies little from patient to patient.

Add to that the fact that adjusting to new medication can take 3-4 weeks, patient’s wellbeing can be seriously compromised.

In essence, these factors mean that by its very nature, depression treatment can be “trial and error”. That is not to say for a moment that doctors are at fault here – let me be abundantly clear that this is not the case, nor is it inferred – it is simply the status quo.

Indeed, doctors do the very best they can with the information they have. But given the complexities associated with mental illness, and the variations in patients, prescribing is at best hit and miss.

In light of this, myDNA has recently launched the “Peace of Mind” campaign – a program run in conjunction with our pharmacy partners, designed to raise awareness of the possibilities for pharmacogenomic testing in treating depression.

myDNA is a multigene pharmacogenomic test that identifies variations in a number of genes affecting the metabolism of many commonly prescribed anti-depressants.

According to Kos Sclavos, the immediate Past National President of the Pharmacy Guild of Australia, pharmacogenomics is the gateway to “personalized medicine”.

He says that “this kind of paradigm shift represents the next generation of healthcare, and technology has enabled pharmacies to be at the forefront of the new frontier”.

In that sense, myDNA places the pharmacy as a key player in the improvement of the lives of people suffering from mental illness, and given the prevalence of it in the general population, such a role has never been so important.

Analysis of 4750 patients who took a myDNA test showed that 6 in 10 people had a finding relevant to their ability to process anti-depressants.

That figure alone is enough to demonstrate the potential for pharmacogenomic testing to dramatically change the treatment landscape for mental illness.

Getting medication and dosage right at the initial prescription unquestionably helps the well-being of the patient, but will also save time and cost – for the physician, the patient, and potentially even the health care system.

Around 80 per cent of common anti-depressants are metabolized by specific CYP450 enzymes that are covered by myDNA’s capability for multigene testing, along with a number of common antipsychotic medications.

To this point, around 12 000 myDNA testing kits have been ordered by Australian physicians, however I’m confident that broader adoption of proactive pharmacogenomic testing is only a matter of time. It’s not if, but when.

I appreciate that pharmacogenomic testing moving into medical practice represents a big shift to accepted practice, and a challenge to conservative treatment. But the opportunity is there for pharmacies to lead off the next generation of healthcare – by delivering a new level of personal information, and thus redefining the patient-doctor relationship.

It’s a chance set new guidelines and break new ground here in Australia.

Certainly, in the United States, authorities are embracing the concept, and it is gradually becoming mainstream – the Department of Veterans Affairs for one already cover the test for patients who fail their first treatment.

The Clinical Pharmacogenetics Implementation Consortium (CPIC) and other international bodies have published guidelines for 67 different drugs including many anti-depressants, while the US Food and Drug Administration provide a list of over 150 labels that carry warnings based on pharmacogenomics biomarkers.