July 31, 2019

Advancing Actionable Clinical Support for Mental Health Providers

Coriell Life Sciences explores the consequences of patient-specific changes in the key gene CYP2D6 in psychiatry

Findings intended to assist frontline providers with better understanding of the ways genetic variation can help guide therapy

There is growing concern for the nearly 40 million U.S. adults who take psychiatric medications that adverse drug events (ADEs) from therapeutic use of these medicines is amplifying the number of patients who visit emergency departments (EDs).  Recent data demonstrate that 1 in 5 of these ED visits result in hospitalization. 

Novel technologies like pharmacogenomics (PGx) analysis look at the genes that control a patient’s ability to metabolize many commonly used drugs and offer important insight into patient physiology which can have a significant impact on psychiatric care and treatment outcomes.  

New research from Coriell Life Sciences explores patient-specific changes in CYP2D6, a key gene involved in the metabolism of up to 25 percent of commonly prescribed drugs including many antipsychotics and antidepressants.

“There are lots of genetic changes that can impact the way a given patient responds to their medication.  In this work, we looked at a particular type of change that can result in much higher metabolism in the patients carrying them.  By presenting this work, we hope to help frontline providers understand when specific patients might need different doses, or different prescriptions altogether,” said Jeffrey A. Shaman, Ph.D., Chief Science Officer at Coriell Life Sciences and lead author of the article.

Shaman notes that while PGx analysis can better inform medication therapy and improve patient outcomes, the research team says it should not be viewed as a panacea. “Pharmacogenomics is not a silver bullet.  It’s really more of a helping hand for doctors and their patients to help zero in on the best possible treatment options. We hope this paper helps foster a better understanding of patient DNA and the ways genetic variation can help guide therapy.” 

Specifically, the research team—including Drs. Joseph P. Jarvis and Arul Prakasam Peter—evaluated the potential benefits and challenges of PGx analysis in psychiatry in the context of accurate measurement and interpretation of data from CYP2D6, including the extensive copy-number variation, numerous single-nucleotide polymorphisms, and the wide variety of hybrid alleles that have been observed at this key drug-metabolizing gene.

The co-authors discuss best practices for overcoming many of the biological and technical challenges involved and examine a variety of current and future applications of PGx analysis of CYP2D6 in psychiatry, in an article titled, “Consequences of CYP2D6 Copy-Number Variation for Pharmacogenomics in Psychiatry,” published online in Frontiers in Psychiatry