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

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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.


Will Pharmacogenetics Help Your Health?

By Pat Allen

Have you ever wondered why some medications work for others and not for you? Do you wonder why you have side effects to some medications, while your friend who takes the same medication has no side effects? Do you often pick up a prescription and pay a copay to find yourself back a few days or weeks later trying a different medication or different dose? Whether a medication will work for an individual depends on several factors – for example, how slow or how fast it metabolizes in your body. Another aspect is whether or not the prescribed medication is best matched to your genetic make-up.

In the United States, there are more than 100,000 deaths annually related to adverse drug effects. According to the Food and Drug Administration, over 700,000 Americans have serious consequences as the result of adverse drug reactions. An estimated 2 million hospitalizations occur yearly as the result. A long-standing approach of “one-size-fits- all” prescribing of medication not only does not work but puts individuals at risk for ADEs, drug toxicity and decreased drug efficacy. As many as 50 percent of medications prescribed are not taken or are stopped prematurely as the result of adverse effects. Many individuals simply stop taking their medication as a result of it failing to work. With respect to antidepressant medications, it’s estimated that medications are ineffective in as many as 38 percent of patients. It’s not uncommon for an individual to try three or four medications before finding one that works without intolerable side effects. The above does not take into account the added health care costs incurred, work lost or the impact on quality of life and family.

A rapidly growing answer to this problem is the use of pharmacogenetics testing. For the last decade, pharmacogenetics testing has emerged as a promising tool. Pharmacogenomics is the study of how genes affect a person’s response to medications both prescribed and over the counter. Pharmacogenetics is the study of genetic variations that influence an individual’s response to medications. Some individuals rapidly metabolize certain medication, while others poorly metabolize a drug. Understanding the way one’s genetic makeup impacts how the body responds to a drug moves the prescriber away from a trial-and-error method. Pharmacogenetic testing provides objective information about what drugs will work, those unlikely to work and those likely to cause side effects.

Pharmacogenetics testing simply entails a swab of the cheek. The sample is sealed, sent to the lab and analyzed. Results are available within two to three days. While there are similarities in vendor test reports, there are variations in the process, services and detail in the report. For example, turn-around time ranges from 24 to 72 hours from receipt of the sample. Support hours vary, with some vendors covering Monday through Friday only. The genetic testing is covered by most insurance companies, including Medicare and Medicaid.

There is exponential growth in the research supporting the value of PGT. The test includes three common panels. However, for the purposes of this article, the focus is on the neuro/psychiatric panel. This panel covers antidepressant, anti-anxiety, anti-psychotic, ADHD and pain. Pain includes neuropathic, migraine and arthritis. There are an increasing number of vendors providing the testing. There are common features of all vendor reports. Since more than 80 percent of medications process through the liver, testing analyzes several key drug-metabolizing enzymes from the cytochrome 450 family. Test results provide information about how fast and efficiently the body will respond to a medication. With respect to psychiatric medications, serotonin and norepinephrine transporter genes provide information about likely effectiveness of the drug. Additionally, the report includes catechol-O-methyltransferase, which relates to the ability to benefit from medications for attention deficit hyperactivity disorder. The modulation of emotion is impacted by COMT. This is very helpful not only with medication, but with lessening anxiety through non-pharmacologic modalities such as group therapy, meditation and yoga.

The report includes the influence of over-the-counter medications, as well as dietary influences, on prescribed medication. Both of these relate to drug-drug interactions. It is an objective tool to guide safe and efficacious prescribing. It guides the doctor or nurse practitioner in choosing the most safe and efficacious medication. It supports informed decision making by the individual. The physician or nurse practitioner meets with the individual to review the report and facilitates discussion about utilizing the results. This enables a partnership in care that empowers the individual. The partnership results in adherence to medication and reduction or resolution of symptoms.

Testing is both an intervention and preventative strategy. Pharmacogenetics testing is an integral part of personalized medicine. It replaces a long-standing trial-and-error approach with the help of science to create personalized medicine. Lastly, pharmacogenetic testing is a one-and-done endeavor. The information gleaned from the test can be used over a lifetime, making it beneficial and cost-effective.

Patricia Allen, MSN, PMHNP-BC, currently practices at Summit Behavioral Health in their PHP, IOP and outpatient services. She received her post-master’s Psychiatric Mental Health Nurse Practitioner at Drexel University, and is currently pursuing a Doctorate in Nursing Practice. Additionally, she practices in an acute behavioral hospital setting. Pat is tenured nursing faculty at Montgomery County Community College, in Blue Bell, Pennsylvania. She teaches mental health nursing and leadership. Several years ago she developed an elective mental health rotation for seniors interested in psychiatric nursing. Pat presented a poster on this endeavor at the annual American Psychiatric Nurses Association (APNA) in 2010 and 2012. She has developed case management programs for those with co-occurring disorders and presented her findings at the APNA and American Association of Occupational Health Nurses (AAOHN) conferences. Over the years she has served in various positions on the Philadelphia area board of directors of APNA, PSNA, CMSA and AAOHN.