The prospect of this new medicinal approach is to adopt a predictive method through determining individual susceptibility to diseases, finding accurate diagnostics, and most importantly to tailor therapeutics according to your genetic makeup. Currently, the majority of success stories in the utilization of personalized medicine are within oncology diagnostic and treatments. For example, a so called ‘magic bullet’ drug, such as traztuzumab, or commonly known the brand name of Herceptin®, is a breast cancer therapy to treat women that are overexpressing the HER2+ gene. This drug is a targeted treatment as the monoclonal antibody will directly act against and inhibit HER-2 to prevent cancer cell proliferation. The success of traztuzumab-based targeted approach has illustrated the early adoptions of pharmacogenetics intervention. However, we can now see great opportunities arising from psychiatry due to growing evidence and increase in treatment demand.
In 2020, nearly 3 million individuals in Indonesia were reported to experience at least one form of mental health issues and this was predicted to escalate by 2024. Alarmingly, mental health funding and health expenditure only make up 1% of the national health budget and 3% of gross domestic product. This insinuates a great proportion of untreated individuals experiencing psychiatric disorders and places them at a risk of mental health deterioration.
The urgency to embrace precision psychiatry will be a revolutionary method to take care of vulnerable individuals in Indonesia and hopefully open doors to a better, patient-centered psychiatry disease management. In this article, we will discuss an unconventional method in treating psychiatric conditions through personalized medication.
How personalized medicine will advance treatments in psychiatry? :Diagnostics
Currently, psychiatric diagnosis and treatment are done by gathering information of symptoms experienced by individuals and classifying them into a particular condition according to the reported symptoms. Although this classification criteria have been considered a reliable method in justifying psychiatric conditions in the past, disease classifications do not reflect the psychobiological mechanism or the interplay of genetics. Following evaluation with phenomenological classifications, psychiatric treatments are usually guided by a general guideline designed for universal patients. For example, it is very common for psychiatrists to recommend antipsychotics and antidepressants for sufferers of schizophrenia and depressive disorder.
With an exponential growth in science and technology and an increasing interest in personalized medicine, this precision approach has been witnessed in the field of psychiatry, introducing revolutionary beginnings and a start of a brand-new era for mental health care.
Researchers have found reputable findings of genetic associations in mental health disorders. A large amount of data was used to discover an underlying polygenic basis of psychiatric disorder or the presence of contributing loci. So far, 10 generic psychiatric disorders are known to associate with over 240 loci, and some are a risk factor for mental disorders. For example, the genome-wide association studies (GWAS) have identified emerging genetic profiles based on neuropsychiatric conditions like schizophrenia in individuals. This data generated from a wide pool of diagnostics leads us to a qualitative shift. In simple terms, a potential biosignature or a set of biomarkers combined with clinical characterization are now available to guide and improve diagnostics. Hopefully, this combined method of clinical characterization and precision psychiatry through genetic profiling will not only be able to improve relevant diagnostics, but also treatment outcomes.
Ultimately, the goal of precision medicine is to “tailor medication to the right patient at the right time”. This precision approach is extremely necessary to improve the field of psychiatry in Indonesia and worldwide and let us show you why.
Precision medicine in psychiatry treatment: Antipsychotics
Although the recorded data for individuals suffering from a psychiatric disorder in Indonesia is relatively small compared to those with physical disorders, about nine million out of over 250 million individuals in reported ever experiencing depression at one point in their lives. Antipsychotics has become the central treatment to combat depressive disorders as well as anxiety and other emotional mental disorders.
Let’s see a case where precision medicine would improve psychiatry related disorders.
A study by Carrascal-Laso et al. has found pharmacogenetic conflicts between drugs and genes after the application of a 5 Step Precision Medicine model (5SPM). The genes used in this study include the cytochrome families or commonly referred to as CYP450. The relationship between these polymorphic genes towards several antipsychotics and confirmed a dose related affect was observed.
As a given example from this research, the psycholeptic drug, aripiprazole undergoes metabolism in the liver through the cytochrome system, more specifically by the CYP2D6 and CYP3A4. It was found that patients presenting a “normal metabolizer” phenotype would favor the use of aripiprazole, demonstrating the near absence of side effects and overall better quality of treatment outcomes. However, those people do not react to olanzapine or clozapine the same way they react towards aripiprazole. This explains their necessity for a greater dose of olanzapine or clozapine to increase their treatment effectiveness. Yet, this has to be done carefully to avoid the intensified adverse reactions. The successes in understanding genetic associations towards several psychiatric treatments have allowed greater institutions to adopt a better approach for substantial improvements in therapy outcome all the while avoiding unwanted side effects of antipsychotic drugs.
This technology has been adopted by Nalagenetics, where four important genes that are most commonly associated with drug efficacy and side effects are analyzed. Your genetic profile will be used by physicians to choose the most suitable treatment. In Nalagenetics, we offer Nala RxReadyTM, a panel covering over 160 drugs, including thoserelated to psychiatric, cardiac, painkillers, and gout treatments.
A large quantity of precision medicine has been focusing on chronic physiological diseases, with a strong emphasis on oncology. With this emerging interest and success in this personalized approach, there seems to be a rising trend and opportunities tapping on precision psychiatry. In Nalagenetics, we offer products capable of understanding the dynamics between your genes and your medication as we fully recognize the importance of ensuring appropriate access to mental health care in Indonesia. Tailor your psychiatric treatment now by using Nala RxReadyTM. Please contact us at 08119941440 for more information. We will be happy to assist.
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