How Can Pharmacogenomics (PGx) Help Those With Anxiety & Depression?

What are anxiety and depression?
Anxiety
Anxiety is probably best thought of as a state of unease or uncertainty with associated worry or fear about something, and can vary in its extent from mild to severe. The sorts of symptoms might include feeling nervous or tense, such as just before an interview or an exam, for example. A sense of impending doom or danger or panic that a situation might present with can be felt.

In these “fight or flight” situations, you might appreciate that your heart rate tends to increase, your breathing becomes more rapid (sometimes called hyperventilation), you can sweat more, start to tremble and feel rather weak or feeble in yourself and you might get a headache or stomach ache. This “adrenalin rush” is an important survival response that has evolved in us to help us adapt to a given situation in terms of confronting an issue or running away from it (in past times running away from a wild animal, for example).

Nowadays, things that can lead to anxiety are more usually relating to matters concerning work, health, relationships, and money worries. You can also become particularly focussed on the worry at hand and overthink things and then find that being able to concentrate on other things can be challenging. In a more general sense, you might have difficulty sleeping, and be distracted and unable to concentrate and be more easily irritated. Lack of sleep can make you more generally tired as well.

Everyone will get some degree of anxiety in everyday situations, but if it starts to become more persistent, and start to impact on your daily living, then help may be needed and there are various things that can help. Talking things through with a close family member or friend or seeing your GP is a good starting point.

Depression

Depression is best described as having a low mood that lasts for weeks or months that affects your everyday life. Typical symptoms of depression might include feeling constantly unhappy or sad, exhibiting low self-esteem or self-loathing, getting angry more easily, being tearful, not getting proper sleep (too little or too much) and failing to get pleasure out of the things that you would normally enjoy.

Many things can lead to depression such as stressful life events, personality, increasing age (depression is more common in the elderly), having a baby, substance misuse, having other medical problems (such as chronic illness or chronic pain, Parkinson’s disease, having a stroke or a heart attack, and cancer) and the tendency to depression can be inherited as well.
Depression can also make the symptoms of other diseases worse too, including arthritis, heart disease, diabetes, obesity, asthma and cancer. The most severe depressive symptoms include thoughts of death, suicide, self-harm or actual suicide attempts.

What can you do to help yourself?
Simple things, like eating well balanced meals, taking time to walk or “chill” in a way that you find relaxing (e.g. yoga or mindfulness works for some, running or cycling or going to the gym for others, etc), reducing your caffeine and alcohol intake, both of which can heighten anxiety/depression states, and just trying to slow down, take long slow intakes of breath, close your eyes and think calming thoughts (when safe to do so!), listen to music and just trying to relax in the best way you can.

What medicines are usually taken to help the symptoms of Anxiety/Depression?
SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed medications by your doctor to help rebalance the relevant neurotransmitters in your brain to assist in making improvements to your mood.
SNRIs (serotonin and noradrenaline reuptake inhibitors) are also used, as are TCAs (Tricyclic antidepressants) and TEACs (tetracyclic antidepressants), which increase the amount of both serotonin and noradrenaline neurotransmitters in the brain.
Less commonly used treatments include NDRIs (noradrenaline and dopamine reuptake inhibitors) and MAOIs (monoamine oxidase inhibitors).

You can see which SSRIs, SNRIs and TCAs are included in the Mantara PGx Test here.

What are the common side effects of taking SSRIs/SNRIs ?
· Nausea, vomiting or diarrhoea
· Headache
· Drowsiness
· Dry mouth
· Insomnia
· Excessive sweating
· Nervousness, restlessness or agitation
· Dizziness
· Sexual problems, including a loss of libido, erectile dysfunction etc
· Appetite effects that can lead to weight gain or weight loss

What are the common side effects of taking TCAs?
· Dry mouth
· Dry eyes
· Blurred vision
· Dizziness
· Tiredness/drowsiness
· Headache
· Disorientation
· Constipation
· Urinary retention
· Low blood pressure
· Weight gain
· Nausea
· Sexual dysfunction

It is also important that if you are taking any of the above medications, that care is taken if you are also on other types of medicines, as interactions are common and need to be taken into account.

How can Pharmacogenomics (PGx) help?
Recent advances in the field of pharmacogenomics (PGx) have shown that there are many variations in our genes and these can affect how a particular medication might work in us and can help determine our risk of suffering potential side effects associated with them.

Because we are all different genetically, knowing what particular gene variants we have can be very helpful to doctors, as they try to decide which medication to prescribe for us.

At the moment, it is a best guess as to which one to start.

PGx takes this guessing bit away, helping the doctor by providing them with the necessary information about your genes and then, which medicine might be the best one for you to start from the outset.

You can see which SSRIs, SNRIs and TCAs are included in the Mantara PGx Test here.

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