You don’t know where to turn — your doctor has prescribed medication after medication for your mental health disorder, but nothing seems to be working. The side effects have included everything from fatigue to weight gain, and you’re fed up. It doesn’t seem fair; you’re just trying to get better and live a normal life, but everything you try comes with a new set of problems.
Finding the method of mental health treatment that works for you is an odyssey through a sea of doctors, specialists, therapies and medications. While most people do eventually find a solution through trial and error, jumping through hoops to get there is exhausting and discouraging. It’s a story told by countless mental health patients. But there might be a faster and more precise way to find your solution — there’s a genetic test that can predict the way your body will respond to certain medications.
To introduce the way genetics can impact your mental health treatment, let’s first recap that long-forgotten biology course. We know that our genes — our DNA — make us different; genes help determine the traits we get from our families, like eye color or skin type. But it’s not quite that simple. What genes really do is determine the way each of our cells function.
Nearly every cell in your body contains a complete copy of your DNA. In each cell, different segments of your DNA are activated — or “expressed” — to help the cell perform its role in your body. For example, the cells of your irises express genes that tell the cells to produce pigments — this gives you your eye color. Likewise, certain skin cells have active segments that produce collagen, a protein that provides your skin structure and resilience. But not everyone’s DNA is expressed in the same way; in fact, it is the differences in our activated genes that make us physically unique.
Among the countless things that your DNA determines is the way your body reacts to certain chemicals — chemicals like those contained in medications. Specific genes, when active, tell your cells to produce proteins that aid in the absorption, processing and breakdown of medications from Tylenol to antiepileptic drugs.
So what does all this have to do with mental health treatments? Somewhat recently, scientists were able to isolate the genes responsible for metabolizing a range of mental health medications, including antidepressants, drugs for schizophrenia and bipolar disorder, medications for anxiety and more. With cutting-edge genetic tests, doctors are now able to identify how your unique DNA processes these drugs — this information can then be used to help your doctor predict the type of medication that your body will react to with best results, eliminating some of the taxing guesswork.
According to a 2007 review published in the peer-reviewed journal American Family Physician, the mechanism at work is a type of metabolic protein — a class of enzyme called cytochrome P450 (CYP450). These enzymes are produced by expressed genes most often found in cells of the liver, as well as some cells in the small intestine, lungs, placenta and kidneys. There are numerous enzymes that fall into the CYP450 category, but scientists attribute nearly 90% of drug metabolism to just six specific forms. The laundry list of medications that these six enzymes help process includes Clozaril, Zyprexa, Valium and SSRIs like Prozac and Celexa.
Each CYP450 enzyme has its own genes that determine how and where it is produced in your body. By taking a sample of your DNA and looking at the specific genes for CYP450 enzymes, your doctor can see how your drug metabolism compares to the average person. In the case of CYP450 tests, there are four possible outcomes:
- Poor metabolizer — Your body processes these drugs very slowly, and leaves much of the active chemicals in your bloodstream. You are more likely to have side effects and other possible complications.
- Intermediate metabolizer — You metabolize more slowly than average, but not as slowly as poor metabolizers. You will likely experience some relief from drug therapy, but symptoms won’t go away completely, and you will be more susceptible to side effects.
- Extensive metabolizer — This category entails an average drug processing rate. The body metabolizes drugs quickly enough to prevent most side effects and to provide symptom relief.
- Ultrarapid metabolizer — Your body processes drugs more quickly than average, which means drugs go through your system rapidly. There is a low likelihood of either side effects or symptom relief.
Understanding which kind of metabolizer you are helps you and your doctor know what kind of medication you’ll respond to, what kind of dose or frequency you might need and what types of medications might cause particularly problematic side effects. It can also help you understand whether other drugs you are taking might react badly with new medications for your mental health disorder.
Genetic Testing Might Be Right for You
Hearing that a “cytochrome P450 genotype panel” might be able to help you treat your mental health disorder could ring some bells in your head. It sounds very technical; maybe very involved, or very expensive. But in fact, this test is simple and is covered by Medicare and many private health insurance plans. It usually only requires a DNA sample (a blood sample, saliva sample or cheek swab) that can be collected by your primary care physician and can sometimes be collected at home. The sample is submitted to a genetic testing lab, which runs a series of tests over the course of a few weeks. Then, you’ll receive a written breakdown of your results, which your doctor can review with you so that you both know how to best proceed with your mental health treatment.
If you have been struggling with mental health treatment and drug therapy for your mental health disorder, you should call your doctor or your insurance provider today to learn more about whether a CYP450 test could help you. Modern technology like these genetic tests allows your providers to deliver personalized care that works specifically for you, your body and your needs. This kind of detailed treatment plan is the future of healthcare, and it’s becoming increasingly easy and available for everyone. Don’t hesitate to take advantage of your options or to ask for help — there is a way for you to find relief from your mental health symptoms, and it doesn’t need to be a painful journey.
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