By Joel Diamond, MD, Co-Founder & Chief Medical Officer of Aranscia and Co-Founder of 2bPrecise
LinkedIn: Joel Diamond
X: @aranscia
Mental health, often paired with behavioral health, is in the midst of a major crisis affecting children and adolescents worldwide. According to a CDC trends report, more than 4 in 10 (42%) students felt persistently sad or hopeless and nearly one-third (29%) experienced poor mental health. In addition, more than 1 in 5 (22%) students seriously considered attempting suicide and 1 in 10 (10%) attempted suicide.
In line with these staggering numbers, physicians are seeing a rise in prescriptions for this patient population. One study found that the prevalence of antidepressants and antipsychotics increased 25% and 19%, respectively, between the years of 2019 and 2021. As the mental and behavioral health crisis continues to grow, physicians and the overall healthcare space must analyze the existing problems in the prescription process and focus on what tools currently exist to help this vulnerable population get the proper medication faster.
The Physician’s Largest Hurdle
The most significant hurdle physicians face when trying to find the proper behavioral health medication for a specific adolescent is time. The standard process of trial-and-error prescribing is a long one, especially in the realm of mental and behavioral health cases where time is of the essence.
Most medications will take at least four weeks to see any benefit, but the actual reaction to the drug is more likely to show around 8-12 weeks. If the patient sees no benefit, the dose is often adjusted and followed by another waiting period before trying the whole process again with a different trial-and-error drug. For children and adolescents with suicidal thoughts, this long treatment plan timeframe is simply too risky. Shortening the process of finding the right drug for the right patient is critical, and that is where pharmacogenomics (PGx), the study of how an individual’s genetic makeup affects their ability to metabolize drugs, can come into the toolkit.
What Can Be Done?
Physicians must learn about and utilize readily available tools like PGx to speed up finding the correct medication for their patients. PGx tests can highlight if a patient has a genetic variant that affects their body’s ability to properly metabolize and benefit from a drug, and PGx testing is now accepted as a simple and significant tool to support prescribing in this population.
The impact of PGx in the mental/behavioral health space is real. I recently saw a high school senior who was thinking of giving up a generous college scholarship due to her ongoing struggles with depression. She had been on 3 different Selective Serotonin Receptor Inhibitors (SSRIs) prescribed by other physicians in the past and was convinced that she had “treatment-resistant depression”. After ordering a PGx test for her, results revealed that all three past medications were inappropriate for her based on her genetics. It was those results that helped to convince her to try another medication, which in fact worked well. Along with counseling, she has improved her self-confidence and is excited to start college next year. This may just be one real-life example, but it shows the impact of what PGx can do for our young patients and how these correct treatments can save their futures.
Implementation
PGx is not new to the adolescent space. Leading organizations have long used PGx in their treatment programs. St. Jude’s pharmacogenomics program has been around for nearly three decades and has tested over 6,000 patients, signifying that the wide-scale application of PGx in a child and adolescent program is both possible and valuable to clinicians. However, for many children and adolescents, large-scale organizations are not where their treatment begins.
For a large part of this healthcare space, the burden of care for treating and prescribing to youths falls on family care and pediatrics. For doctors in these types of practices, PGx is one of the most accessible tools that can be added to a mental and behavioral health program to improve patient treatment plans. By moving a PGx test up in the treatment timeline, both physician and patient can benefit from the time savings and improved outcomes. And implementing PGx testing is now easier than ever, with companies nationwide having the ability to deliver test results directly into the physician’s workflow, meaning there are few to no extra steps for a physician to use the results while in the prescription process.
As the youth mental health crisis continues, the healthcare space is responsible for adapting to new technologies to ensure that the fastest, highest quality of care is given to ensure our youth are properly treated in a timely manner. Bringing PGx into a facility enables the provider to prescribe the right drug at the right dose to the right patient, sooner – which can have an invaluable impact.