Personalized medicine: Improved mental health treatment guided by DNA
A growing body of evidence indicates that personalized medicine, or treatment guided by your DNA, improves mental health outcomes. A randomized clinical trial in Canadian community pharmacies found that Pillcheck pharmacogenetics-guided medication therapy improved depression, anxiety and disability more than standard care.
Finding the right depression treatment is often challenging
Only about one in three people with depression reach remission with the first antidepressant they try. If the first medication doesn’t help, the second or third often will, but each attempt can take weeks. Many people who could benefit from an antidepressant never try one, often because they worry about side effects. Some do not find relief even after trying several medications.
Established science of pharmacogenetics
In past years, clinical studies showed that genetic variations impact medication effectiveness. In fact, more than 9 in 10 people carry at least one genetic variation that can affect how they respond to commonly prescribed medications. Unfortunately, most health systems and medical practices are not yet designed to accommodate genetic insights in routine care. The Pillcheck service is built on the established science of pharmacogenetics (also called pharmacogenomics, or PGx) and follows evidence-based guidelines from the Clinical Pharmacogenetics Implementation Consortium (CPIC). With PGx insights, we can predict how a person is likely to process many medications, which helps guide the choice and dose.
New evidence supports personalized medicine for mental health
Pillcheck combines DNA analysis with an online medication review by expert pharmacists. Recently published results from an independent study using Pillcheck confirmed the impact of this prescribing approach to tailoring drug treatments for people struggling with mental health.
How does PGx testing affect outcomes for mental health conditions?
The study found that people with anxiety and depression improved more when their treatment was informed by their genetics. This randomized controlled trial followed 213 people filling prescriptions at three Shoppers Drug Mart pharmacies in busy, multi-ethnic neighbourhoods in Ontario.
Method
For the randomized clinical trial NCT03591224, pharmacists asked patients taking medications for anxiety and depression if the current treatment was working well for them. Patients who reported side effects or poor mood were enrolled in the study.
The study assessed all participants for depression severity with standardized medical questionnaires.
All study participants provided a cheek swab for DNA analysis and were randomly assigned to the control group (“treatment as usual”) or the Pillcheck group.
Pharmacists provided standard medication reviews and recommendations on possible treatment options without seeing DNA test results in the control group. While in the Pillcheck group, pharmacists informed doctors why some medications did not work or caused side effects and provided their recommendations based on the patient’s drug PGx profile.
Prescribers were able to accept, decline, or disregard these recommendations. Patient-reported outcomes were assessed at regular intervals over six months. The study revealed that improvements in depression, anxiety and disability were about two times greater in the Pillcheck group than in the control group:
- Depression improved by 36% in the Pillcheck group versus 18% in the control group.
- Anxiety improved by 41% versus 23%.
- Disability, measured with the Sheehan Disability Scale, improved by 44% versus 18%.
Because prescribers knew which group their patients were in, the authors note that some bias cannot be ruled out, and they recommend further blinded studies.
Pillcheck improves management of depression
The randomized controlled trial has shown that Pillcheck’s method of delivering genetic results is very effective: it enables pharmacists to identify drug therapy problems for individual patients and advise their physicians on personalized treatment options. Furthermore, doctors were more receptive to Pillcheck-based pharmacist recommendations: prescribers accepted 75% of them, compared with 53% of standard pharmacist recommendations without PGx.
What does it mean when patients are in the driver’s seat?
Pillcheck helps customers derive the full value of the investment in a genetic test by combining genetic insights with pharmacological expertise. Together, they allow for more effective medication selection and dosing. Among the best practices is informed consent and enabling individuals to control access to their genetic testing results. Pillcheck customers can elect to share their results with any healthcare practitioner they choose.
Since our DNA doesn’t change, Pillcheck is valid for life, and Pillcheck updates each report for new medications as guidelines expand, at no additional cost. The test is performed in CAP- and COLA-accredited clinical genetic laboratories in Canada. Pillcheck reports on 24 genes, increasing coverage with new guidelines and drug labels (see the genes tab), and covers 355 medications, which account for over 70% of dispensed prescriptions. Using Pillcheck results repeatedly over time and bringing them to any doctor makes Pillcheck a medication passport for life. Customers often comment that Pillcheck gave both them and their doctor the confidence to change their medications without worry. Health outcomes improve when patients and physicians are on the same page and work together to understand the treatment and diagnostic options.
Frequently asked questions
Does pharmacogenetic testing help with depression and anxiety?
In a randomized controlled trial in Canadian pharmacies, people whose treatment was guided by Pillcheck improved about twice as much in depression, anxiety and disability over six months as those who received standard care.
Can a DNA test tell me which antidepressant will work?
No test can guarantee that. A pharmacogenetic test shows how your body is likely to process many medications, which helps your doctor choose a medication and dose with a better chance of working and fewer side effects.
Who sees my results?
You do. You choose which healthcare providers to share your Pillcheck results with.
Do I need to repeat the test?
No. Your genes do not change, and your Pillcheck report is updated as new guidelines and medications are added.
References
Papastergiou J, Quilty LC, Li W, et al. Pharmacogenomics guided versus standard antidepressant treatment in a community pharmacy setting: A randomized controlled trial. Clin Transl Sci. 2021;14(4):1359-1368.
Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905-1917.
Bousman CA, Stevenson JM, Ramsey LB, et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A Genotypes and Serotonin Reuptake Inhibitor Antidepressants. Clin Pharmacol Ther. 2023;114(1):51-68.
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