Category

Blogs

How the Pandemic Has Affected Mental Health; How Pharmacogenetics Can Help

By Daniel Lehewych

May 11, 2021

The COVID-19 pandemic has brought with it a lot of consequences that are distinct from the virus itself. One such consequence has been a dramatic rise in mental health problems. Despite this devastating rise, hope should not be lost. Pharmacogenetics can help aid the process of treating mental illness.

Rising Mental Health Problems

Society, in general, did a great job with social distancing and quarantine during the pandemic. Without these efforts, millions of more people would have gotten sick, and therefore, many more deaths would have been more likely to occur. However, these measures came at a cost.

Human beings are intrinsically social animals. This can be demonstrated in a few ways. A salient way is the fact that, without sufficient human contact, newborn infants can either have irrecoverable health complications for the rest of their life, or they can even die. Another salient example is punishment via solitary confinement: being totally cut off from human contact is actually considered less tolerable for inmates generally, than being socially in proximity to dangerous criminals. So being around each other is crucial for our development and psychological well-being.

The pandemic has forced us away from each other. Many of us went through the holidays without seeing anyone, and many of us haven’t seen our loved ones in a long time. That is to say, due to the pandemic, to some degree, what it is to be a human –namely, to be socially in the world– has been severely interrupted.

Largely because of this, we have seen a significant rise in mental health issues in the general population. We have seen this rise take many forms. For instance, it has been reported that four out of ten adults in the United States have reported experiencing symptoms of anxiety or depression during the pandemic. To put this into context, prior to the pandemic only one out of ten adults in the United States reported experiencing symptoms of anxiety or depression. These measures are quite consistent with the data we have on the psychological effects of quarantine: namely, that someone who is quarantined is much more likely to develop mental health problems than someone who is not quarantined.

Another worrying statistic regarding mental health is a rise in substance abuse. There is emerging evidence that heavily suggests that alcohol abuse has increased significantly during the pandemic. Similarly, there is evidence now that suggests that general drug abuse is also on the rise because of the pandemic. On top of this, the rate at which drug overdoses have been occurring skyrocketed during the pandemic. Specifically, according to the CDC, in 2019 there were 70,000 drug overdose deaths in the United States 2019; in 2020, this number went up to over 88,000 deaths.

Finally, COVID-19 and post-traumatic-stress-disorder (PTSD) have an inter-related relationship. On the one hand, it has been reported that about one-third of COVID survivors who had severe cases may have or or could develop PTSD. On the other hand, along with feelings of anxiety and depression, reports of PTSD have been on the rise since the beginning of the pandemic. Healthcare workers are particularly vulnerable to these effects. The stress of this entire pandemic is getting to many of us, which is one of the ultimate sources of this rise in mental health problems.

 

Pharmacogenetics

The healthcare system –including the part of it that pertains to mental health– has attempted to adapt in light of the pandemic. Telehealth allows us to see our providers with zero risk of getting infected with the virus. However, an age old problem remains and has gotten potentially worse due to the pandemic: psychiatry is notorious for its “trial and error” method of treatment. For the most part, when you go to a psychiatrist, they will prescribe a medication to you depending upon your symptoms and/or diagnosis. The idea here, is that you will try out the medicine to see if it works. If it doesn’t –which is quite common– the doctor will prescribe you a different medication to see if that works. This process will continue until you and your doctor find the right medication for you. Unfortunately, sometimes people never find the right medicine for them, leaving them feeling more hopeless than before they started seeking treatment. In a world with increasing mental health issues, this way of going about treatment may need to be re-envisioned with something new and more accurate.

Pharmacogenetics is the solution to the trial and error method of psychiatry. Pharmacogenetics, in layman’s terms, is when a doctor orders a genetic test for a patient for the purpose of accurate and effective medical prescriptions. So, instead of testing out all of the SSRI’s when you are depressed, pharmacogenetics can by-pass this process, by telling the patient which SSRI will have an increased likelihood of a positive response for them with less adverse reactions based upon their genetic profile. The purpose of pharmacogenetics is to individualize treatment for patients and in doing so, ameliorate any of the unnecessary suffering that goes along with the trial and error method of psychiatry. There is already a large body of research substantiating the effectiveness of pharmacogenetics’ ability to do this in the domain of psychiatry.

Therefore, it is imperative in any effective psychiatric treatment plan to include pharmacogenetic methods of prescribing medications. As mental health issues rise, the hope is that access to pharmacogenetic methods becomes more accessible to more patients. In some sense, such increase access is essential to ending our current mental health crisis –the trial and error method, if anything, continues to exacerbate it. It is possible that, with the removal of the trial and error method and the initiation of pharmacogenetics within a treatment plan, the reduction in stress by getting streamlined treatment could potentially reduce rates of self-medication, and put patients on the road to recovery much quicker.

Behavioral Health vs. Mental Health: How Both Relate to Pharmacogenetics

image from freepix.com

Daniel Lehewych, March 19, 2021

Key Takeaways:

 1. Behavioral health is simply the connection between one’s behaviors affect one’s health at any level. This includes physical health, psychological health, and even spiritual health. Mental health is merely one aspect of behavioral health. It is also simply one way of understanding mental health.

2. Mental health is the state of our psychological, emotional, and social well-being.

3. Pharmacogenetics is the study of how people respond differently to medications based upon their genetics. Pharmacogenetics can inform the treatment of mental health and behavioral health conditions by improving the efficacy of drug selection to suit an individual’s genetic profiles.

Behavioral health and mental health are often lumped in together, as either synonymous or similar enough to consider under the same light. However, behavioral health and mental health are not the same things. They are certainly interconnected, but when it comes to treating either a behavioral health condition or a mental health condition, they need to be treated differently. This is especially the case when one utilizes pharmacogenetic methods to determine which medication a patient should be on.

What is Behavioral Health?

 Behavioral health is, at bottom, the connection between one’s behaviors and the state of one’s health in any way. For instance, smoking cigarettes –which could lead to cancer– is a behavioral health problem. Another example is overeating, which is a behavior that could lead to obesity. In essence, behavioral health is a comprehensive concept under which any health condition –whether it is a mental or physical health condition brought about by specific behaviors fits.

 

What is Mental Health?

 Mental health is the state of one’s psychological, emotional, and social well-being. A mental health condition is a condition whereby one’s psychological, emotional and social well-being is negatively impacted. Some signs of a mental health condition might be –though are by no means limited to– problems at work, problems in your relationships, school problems, feelings of anxiety, and feelings of depression. Some mental health conditions can lead to behavioral health conditions, as mental health conditions affect how people behave, quite often to the detriment of their health and well-being.

 

What is Pharmacogenetics? Why is it useful?

 Pharmacogenetics is the scientific study of how specific drugs/medications interact with any given individual’s genetic profile. The reason this is useful is that it can help combat what is often known in the medical community as the “trial-and-error” method of prescribing medications to patients. For instance, it is well-known that prescribing medication in oncology is largely done through trial-and-error. If a patient doesn’t react well to a certain drug, they will continue to try new ones until they find the one that works for them. The utility of pharmacogenetics is to bypass the trial-and-error method of prescribing medications. Quite often, the reason why patients react badly to medications is that the genetic profile of that person has determined their ability to metabolize, absorb, distribute and excrete certain drugs in such a way that causes uncomfortable side-effects. Pharmacogenetic allows doctors to view the possibility of such interactions ahead of time to avoid the possibility of negative side-effects.

 

Pharmacogenetics and Behavioral Health

 Genetic testing, in general, can be profoundly helpful when treating behavioral health conditions. Firstly, genetic testing can be profoundly valuable for the preventative care of potential behavioral health conditions. Genetic testing can help patients understand what behavioral health conditions they are genetically susceptible to. By doing so, doctors can provide guidelines on how to prevent the development of certain behaviors.

In terms of pharmacogenetics itself, if a doctor decides that medication is a good option for the behavioral health condition in question, through pharmacogenetics, that doctor can pick the most effective and least side-effect-creating of drugs for their patient. For instance, let us say that a patient has a problem with smoking cigarettes. There are a few drug options that a doctor might pick from in order to treat this problem. There is a profound amount of individual variability in terms of how people respond to these drugs. Utilizing pharmacogenetic testing can help doctors determine which drug their patient will most likely have the best reaction to.

 

Mental Health and Pharmacogenetics:

 Psychiatric drugs are notorious for their individual variability. Take SSRIs, for instance. The idea behind all of them is the same: they are supposed to increase levels of serotonin in the brain by blocking serotonin receptors. There are many SSRIs. This is because there is such a wide-variety of responses to these drugs that people usually need to try several of them before they find the one that works for them. This process can take months for patients and it can also entail enduring some brutal side-effects on top of already existing uncomfortably from their mental health conditions.

There are a few ways that pharmacogenetics can help with the treatment of mental health conditions. Firstly, like behavioral health conditions, pharmacogenetic testing can help doctors prescribe medications in a way that caters towards their genetic profile so as to maximize positive effects and minimize negative effects. Secondly, the information which is collected through pharmacogenetics can be utilized to create new drugs. These drugs would cater to patients with specific genetic profiles. Such catering would entail that those with specific genetic profiles would receive the maximum amount of benefit from the drug while minimizing negative effects from the drug.

Pharmacogenetics has, in the past 17 years, revolutionized medicine in a profound way. For both the doctor and the patient, pharmacogenetics makes the process of prescribing and taking a medication much smoother and less rife with worries about negative side-effects. Especially within the context of behavioral health and mental health, pharmacogenetics and genetic testing, in general, should begin to be more prominently considered a fundamental pillar of treatment for doctors. It will reduce the risk of liabilities, make the job of selecting medications easier and more accurate, and it will make patients far happier with the results of their visit to the doctor’s office.