How to Choose the Best Medication for Depression or Anxiety
As someone who has faced some challenges with anxiety and depression, I’ve learned that finding the right medication can feel a little hit and miss. Drugs like citalopram, escitalopram, and sertraline are commonly prescribed, but the decision often hinges on several factors: your symptoms, any history of side effects, and potential interactions with other medications—or even with certain foods.
One surprising example? Sertraline’s interaction with grapefruit juice. Apparently, Grapefruit juice inhibits certain enzymes, particularly CYP3A4, which can cause stronger side effects or toxicity. These nuances make personalised prescribing even more valuable.
Introducing Pharmacogenomics and Personalised Prescribing
While Earthy30 is a hobby, my day job is CMO at The AttoGroup. One of the brands, AttoDiagnostics, empowers healthcare providers and patients to take charge of their treatment plans through pharmacogenomics (PGx). This innovative science explores how your genetic makeup influences drug metabolism and response, making it possible to identify the medications that are most likely to work for you.
When I joined AttoDiagnostics, I had the chance to try the Mental Health PGx test. Having had a few episodes with anxiety and depression over the years, I was eager to see how my genetic profile could explain my experiences with various medications with a simple at-home DNA test.
Once the genetics-based results are analysed, the report divides medicines/drugs into three groups:
Mild or no known drug-gene interaction
Moderate drug-gene interaction
Serious drug-gene interaction: avoid/select alternative
A deep dive is then given on each drug which will likely make some sense to “you the consumer,” but will have a lot more relevance to your doctor. Only your doctor should prescribe or change your medications.
DNA test to explore how your body reacts to medicines
My Journey Through Medications
In my 30s, I was prescribed citalopram, a selective serotonin re-uptake inhibitor (SSRI). My First Prescription for Anxiety! While it worked moderately well, my anxiety didn’t fully resolved, and I noticed some weight gain. Moving overseas for work brought new stressors, and my doctor in the U.S. recommended switching to Viibryd (vilazodone).
A New Approach with Viibryd
Viibryd worked incredibly well for me. My anxiety decreased significantly, and I felt more stable overall. After relocating to sunny Los Angeles, I embraced a healthier lifestyle and, with my doctor’s guidance, decided to taper off the medication.
Returning to Sertraline
Years later, back in the UK and facing a difficult work situation, my doctor prescribed sertraline. This time, the medication seemed more effective than citalopram had been, and I used it for about a year before discontinuing as my circumstances improved.
What My PGx Test Revealed
The Mental Health PGx test from AttoDiagnostics offered fascinating insights into my treatment history. Here’s what I learned:
1. Citalopram
My report showed that I am a rapid metaboliser of citalopram due to the expression of the CYP2C19 gene. The report says:
“Increased metabolism of citalopram and escitalopram to less active compounds compared to CYP2C19 normal metabolisers. Lower plasma concentrations decrease the probability of clinical benefit.”
This explained why citalopram didn’t work well for me—my body processes it too quickly for it to be effective.
2. Sertraline
For sertraline, the report indicated:
“Normal metabolism through CYP2B6 gene, but rapid metabolism through the CYP2C19 gene pathway.”
This results in small increase in metabolism of sertraline to less active compounds compared with CYP2C19 normal metabolisers.
The say,
“Initiate therapy with the recommended starting dose (per CPIC strong recommendation).”
This alignment with my genetic profile likely explains why sertraline proved more effective than citalopram.
3. Viibryd (Vilazodone)
Although my report didn’t specifically address vilazodone, I did some additional research. Viibryd is primarily metabolised by CYP3A4, with minor roles for CYP2C19 and CYP2D6. According to my PGx results, I am a normal metaboliser for CYP3A4, which likely contributed to Viibryd’s success.
A Reassuring Takeaway
For me, the PGx test was a game-changer. It validated my experiences with various medications and provided a roadmap for future treatment options. If I need medication again, I’ll feel confident sharing this information with my doctor to make more informed decisions.
Out of curiosity, I also explored a non-mental health example: methotrexate, which my mother took for rheumatoid arthritis. My PGx report lists it in the “use as directed” category, which is reassuring given my elevated Anti-CCP levels—a potential precursor to rheumatoid arthritis.
Why Pharmacogenomics Matters
Personalised medicine through PGx testing has the potential to transform treatment experiences for so many people. By understanding how your genes affect medication response, you can avoid trial-and-error prescribing, reduce the risk of side effects, and achieve better outcomes faster.
At-home DNA testing is a convenient way to access these insights and take control of your health journey. If you’re a practitioner curious about PGx testing, visit AttoDiagnostics to learn more about how this innovative science can help you or your loved ones. For consumers, head to AttoPGx where you can choose between a range of tests, from just Mental Health, to the comprehensive package that covers 115 different medications across conditions including cancer, cardiovascular, birth control and pain management.
TRY PGX FOR LESS
If you enjoyed this article and would like to explore PGx Testing, you can use the code EARTHY10 for £10 off on any product from AttoPGx.
