The smart approach to prescribing medications should avoid the usual ” try this because it might work, or it might not work”. The smart approach to prescribing medications should be based on the patient’s unique genes.
This is especially important for medications used for depression, anxiety, mood disorders and other mental health concerns.
The smart approach is called targeted or personalized prescribing. The question is how does a doctor get the information to do the targeting or personalized prescribing.
The information should be based on the patient’s genes. It is an analysis of his/her genes that provides this information. A saliva test is all that is required. The report provided by a credible genetics lab, such as Inagene in Toronto or Personalized Prescribing, contains all the information that the doctor needs to do personalized prescribing.
The report from the genetics lab tells the doctors which medications to use and which to avoid. It also tells the doctor about dosing the medications. And which other medications of substances such as cannabis will interfere with the prescribed medication.
Everyone metabolizes medications in different ways. Some patients are rapid metabolizers and require higher doses. Some patients are slow metabolizers and require lower doses.
The tests are easy to organize. Go to the lab’s web site. Register. Get a kit. Collect a saliva specimen. Submit the specimen by mail. And the result will be a comprehensive analysis of your genes as they relate to medications. Send a copy of the report to your doctor.
Betsy was 33 years of age. She had gotten increasing sad over the last year or so. She was also anxious. She went to her family doctor. The family doctor prescribed an antidepressant that worked for a while but then stopped working. The family doctor wanted to switch Betsy to another antidepressant. She took the new antidepressant and stopped the first antidepressant cold turkey. That was a mistake. It should have been tapered slowly. This resulted in Betsy becoming ill as she withdrew from the first antidepressant and got a full dose of the second antidepressant.
Betsy’s enlightened friend who is also a doctor suggested the inagene test. The results showed that Betsy had a number of gene mutations including the CYP2C19 gene variant. The inagene report suggested that the doctor use another antidepressant. And if this specific antidepressant was used that the doctor should consider a 50% dose reduction.
Her family doctor was not interested in the genetics report. However, Betsy had been referred to a young psychiatrist who was totally up to date on the science and understood how to interpret the genetics report, how to select the correct antidepressant and how to dose the medication based on the patient’s genetic report.
Prescribing medications is usually an experiment that might fail. Now with genetic testing of patients, doctors can have the information that helps them and the patients by helping with the selection of the right medication and then by helping with the decision about dosing.
The key for patients is to find a doctor who understands or is willing to learn how to use personalized or targeted prescribing based on the patient’s own genetic information.
Keep well. Be safe.
Raymond Rupert, patient advocate and healthcare consultant.