Since 1949, Mental Health Awareness Month has been shining a spotlight on the importance of mental wellness for overall health. It’s a message that resonates across the globe, as the World Health Organization (WHO) estimates that some 970 million people worldwide are living with a mental disorder [1]. Higher income countries report the highest rates of mental illness, with antidepressant prescriptions highest in Iceland, the United States, Australia, UK and Sweden [2]. Each year in the United States alone, 1 in 5 adults experience mental illness and 1 in 20 adults experience serious mental illness [3]. A recent survey suggests the numbers are even higher in the European Union, with 46% of respondents reporting that they have experienced an emotional or psychosocial problem, such as feeling depressed or anxious, in the past twelve months [4].The economic value associated with this global burden is enormous, now calculated to be about USD 5 trillion [5].
Medication use for mental health disorders is on the rise
Treatment plans for mental health disorders typically include multiple interventions such as education, social support, counseling, and psychotropic medication. Of these, recent research has shown that medication use has increased sharply, especially post-pandemic. One analysis found that in the United States in 2022, mental health-related prescriptions were up 12% from 2019, far surpassing the less than 1% growth in overall prescriptions [6]. This mirrors other data showing that antidepressant use is rising globally [7].
As mental health-related prescriptions increase, so do frustrations associated with finding the drug that is most effective for each patient. Many of the medications prescribed for mental illnesses can cause adverse drug reactions and other side effects. That means prescribers often rely on “trial and error” as they work to identify which medications are not only helpful, but also well-tolerated [8].
The clinical utility of pharmacogenomic testing for mental health
Using pharmacogenomic (PGx) testing can help reduce the need for “trial and error” prescribing of psychotropic medications. PGx testing is a core element of precision medicine that assesses how a patient’s genes can affect the way their body responds to and reacts with certain medicines. Taking advantage of an individual’s genomic information, PGx testing can be used to identify which drugs are the most suitable and which ones could cause adverse reactions, as well as the most effective and safest dosage. These results are then used to customize each patient’s treatment plan.
Several studies have shown the clinical utility of PGx testing for mental health conditions. For example, the authors of a 2018 meta-analysis concluded that “pharmacogenetic-guided decision support tools (DST) treatment for major depressive disorder (MDD) is superior to treatment as usual in relation to remission likelihood, specifically among those with inadequate response or intolerability to previous psychotropic medications and perhaps more noticeably among individuals with more severe depressive symptoms” [9]. Other research focused on pharmacy costs for patients using psychotropic medications and found that antidepressant and antipsychotic prescribing that was guided by PGx was associated with significant savings [10].
While studies like these point to the benefits of PGx testing for prescribing psychotropic medication, widespread clinical adoption will require even more evidence for clinical utility and economic effectiveness, as well as greater stakeholder awareness [11]. Overcoming these barriers will lead to better, more personalized treatments for people with mental illness.
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References:
- World Health Organization, Mental Health Overview
- The Guardian, Mental Illness: is there really a global pandemic?
- National Alliance on Mental Illness, Mental Health By the Numbers
- Eurobarometer: Mental Health
- Quantifying the global burden of mental disorders and their economic value
- USA Today, “Mental health crisis fuels the post-pandemic rise in medication use”
- Statista, Consumption of antidepressants in selected countries in 2022
- Barriers to clinical adoption of pharmacogenomic testing in psychiatry: a critical analysis
- Pharmacogenetic tests and depressive symptom remission: a meta-analysis of randomized controlled trials
- Canadian Medication Cost Savings Associated with Combinatorial Pharmacogenomic Guidance for Psychiatric Medications
- Barriers to clinical adoption of pharmacogenomic testing in psychiatry: a critical analysis