A look at using pharmacogenetic testing in determining depression treatment

One young man is on the road to recovering from depression following timely pharmacogentic testing through his employer.

Allison Hazell, director of genetics at Medcan, presented the case study during her presentation on genetics and pharmacogenetics at the company’s event in Toronto on Friday.

The patient, a 28-year-old Medcan employee, had a history of depression. However, he managed it on his own without seeking treatment. “Then he had a major anxiety attack that really scared him and debilitated him in terms of being able to come to work, and he decided to talk to his doctor,” said Hazell.

Read: A look at one company’s experience with pharmacogenetic testing

The man experienced significant and immediate weight gain, which Hazell noted exacerbated his depression, so he stopped the medication, returning to his doctor who prescribed a different medication. Based on his previous side-effects, the man was nervous and opted not to take the new drug. Instead, he tried once again to manage his depression himself.

“One of the benefits at Medcan [is] he can just walk down the hall and speak to me,” said Hazell. “And he was asking about pharmacogenomics and whether this was something that could be applicable for him in his situation.”

Opting to explore pharmacogenetic testing through his employer, the young man found out that 20 medications weren’t the right fit for him. “Had he taken the second medication from his doctor, he very well could have gone through a few cycles of getting medications that weren’t going to work well for him,” said Hazell. “He took this report to his doctor who prescribed a medication wherein his metabolism was normal and he’s doing very well right now.”

Read: Telemedicine, pharmacogenetics among services in Medcan’s new health program

Beyond the return on investment from saving on drugs that don’t work, pharmacogenetic testing has a major impact on patient and plan members’ quality of life, noted Hazell.

In an organization with 10,000 employees, a seven per cent incidence of major depressive disorder would affect 700, she added. “That’s 700 members who may be prescribed an anti-depressant. What we know is that [while] 53 per cent of those people are likely to respond to that first-line therapy, 47 per cent are not. And we have this treatment-resistant phase. Three hundred and twenty-nine members are going now into this next cycle of trying new medications and weening on and off. It’s quite a time-consuming process; you can’t just stop taking these medications, you have to ween up and then ween down. And you basically have a year of trial and error.”

In terms of costs, including drugs and the impact on productivity, the amount faced by this particular organization would be about $7 million, said Hazell.

Read: The debate over corporate health screenings: Do they lead to over-diagnosis?

“If you change that and, from the 47 per cent who don’t respond to medication you then give them a pharmacogenetics test, you can essentially avoid those downstream, that next year of trial and error, trying to get them on the right medication. The predicted savings is $1.4 million.”

Another growing area in the health-care industry is hereditary cancer screening. While it isn’t being talked about in the Canadian employer space yet, according to Hazell, it is a growing trend in the U.S. and she expects to see it come to Canada. She noted a number of companies in the U.S. are offering proactive cancer screening, including Levi Strauss and Co., Slack Technologies and Visa Inc.

“It’s one of the things to have on your radar,” she said.