- ClarityX Mental Wellness Test
- Is Anxiety Genetic?
Is Anxiety Inherited?
Genetic Testing For Anxiety
by Melissa Smith, PharmD, CPH
According to the Morbidity and Mortality Weekly Report (MMWR) from the Center on Disease Control and Prevention (CDC) the percentage of adults with more recent symptoms of anxiety and depressive disorders rose from 36.4% to 41.5% from August 2020 to February of 2021.[2] With growing concern in mental health in society, it is imperative that mental health care teams have access to the most up to date diagnostic tools to help their patients. Pharmacogenomics (PGx) testing is an evidence based genetic test that can help providers find the most appropriate therapy for their patients. ClarityX has a specialized PGx test called the Mindwell test that provides insights specifically to mental health medications unique to their patient’s individual genetic profile.
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Anxiety Disorders
Treatments for Anxiety Disorders
The key players when first prescribing medications for anxiety disorders fall into the following classes of medications: Serotonin Reuptake Inhibitors (SSRI’s), Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s), Tricyclic Antidepressants (TCA’s), and Benzodiazepines. Some examples of commonly utilized medications by providers are citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), venlafaxine (Effexor), duloxetine (Cymbalta), and alprazolam (Xanax). All these medications have pharmacogenomic supporting evidence that can help providers in deciding which therapies would be most appropriate for their patients based on their genetics.[5]
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Pharmacogenetic (PGx) Testing Overview
There are typically five ways to identify genetic variations in these enzymes in PGx testing they are as follows: Poor Metabolizer, Intermediate Metabolizer, Normal Metabolizer, Rapid Metabolizer, and Ultra-Rapid Metabolizer. These labels foreshadow how medications can be broken down in the body or activated. Low enzymatic activity may prevent a patient from metabolizing medications like antidepressants and antipsychotics. When the drugs remain in the system too long, they can cause serious side effects. In contrast, in those with high levels of enzymatic activity, medications can break down too quickly resulting in no therapeutic benefit.
According to the Clinical Pharmacogenetics Implementation Consortium (CPIC) there is meaningful, well documented evidence to support the findings around the enzymes CYP3A4 and CYP2C19 being affected by genetic variations. The genetic variations of these enzymes have been clinically shown to alter the effects of serotonin reuptake inhibitors (SSRIs) and benzodiazepines, which are common first-line therapies prescribed when treating anxiety disorders. Patients potentially could experience treatment failure if these genetic variations are not identified prior to initial treatments. In addition, nearly 25,000 patients annually in the United States will need to go to the emergency department due to adverse events caused by antidepressants.[7]
SSRIs Affected by Genetic Variations in CYP2C19
Benzodiazepines Affected by Genetic Variations in CYP3A4
Mindwell Test Benefits
Citations
[1] U.S. Department of Health and Human Services. (n.d.). Anxiety disorders. National Institute of Mental Health. Retrieved May 9, 2022, from https://www.nimh.nih.gov/health/topics/anxiety-disorders
[2] Centers for Disease Control and Prevention. (2021, April 1). Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19 pandemic – United States, August 2020–February 2021. Centers for Disease Control and Prevention. Retrieved May 9, 2022, from https://www.cdc.gov/mmwr/volumes/70/wr/mm7013e2.htm
[3] What are anxiety disorders? Psychiatry.org – What are Anxiety Disorders? (n.d.). Retrieved May 9, 2022, from https://psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
[4] Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Gautam, A. (2017, January). Clinical practice guidelines for the management of Generalised Anxiety Disorder (GAD) and panic disorder (PD). Indian journal of psychiatry. Retrieved May 9, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310105/
[5] Anxiety Disorders. PharmGKB. (n.d.). Retrieved May 9, 2022, from https://www.pharmgkb.org/disease/PA447196/clinicalAnnotation
[6] https://www.pharmgkb.org/whatIsPharmacogenomics
[7] Hicks, J. K., Bishop, J. R., Sangkuhl, K., Müller, D. J., Ji, Y., Leckband, S. G., Leeder, J. S., Graham, R. L., Chiulli, D. L., LLerena, A., Skaar, T. C., Scott, S. A., Stingl, J. C., Klein, T. E., Caudle, K. E., & Gaedigk, A. (2015). Clinical pharmacogenetics implementation consortium (CPIC) guideline forcyp2d6andcyp2c19genotypes and dosing of selective serotonin reuptake inhibitors. Clinical Pharmacology & Therapeutics, 98(2), 127–134. https://doi.org/10.1002/cpt.147
[8] Hicks, J. K., Bishop, J. R., Sangkuhl, K., Müller, D. J., Ji, Y., Leckband, S. G., Leeder, J. S., Graham, R. L., Chiulli, D. L., LLerena, A., Skaar, T. C., Scott, S. A., Stingl, J. C., Klein, T. E., Caudle, K. E., & Gaedigk, A. (2015). Clinical pharmacogenetics implementation consortium (CPIC) guideline forcyp2d6andcyp2c19genotypes and dosing of selective serotonin reuptake inhibitors. Clinical Pharmacology & Therapeutics, 98(2), 127–134. https://doi.org/10.1002/cpt.147
[9] Clinical Annotation for CYP3A4*1, CYP3A4*22; alprazolam; adverse events, Alcoholism and Anxiety Disorders (level 3 Toxicity). PharmGKB. (n.d.). Retrieved May 9, 2022, from https://www.pharmgkb.org/clinicalAnnotation/1451725560
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