Meds and Your Head
Written by Tanya Goldfrad, R.P.H., M.P.H.
Medications aren’t magical. They are based on science. In basic pharmacology I was taught that medication brings relief to patients using a “lock and key” method. When the right key is inserted into the correct lock – voila! Relief ensues. For anyone who has ever taken a medication and not felt a difference you can vouch for the fact that sometimes the “keys” don’t always work with the “lock” you have. This can happen with all sorts of medications. The worst ones though are medications for mental health. With pain or blood pressure medication we know quickly (maybe after a half hour or even a few days) if the medicine is right for us. But medications that work in the brain take more time to work. In fact, most take between 6-8 weeks just until we can tell if they are helping. Now, for someone who is suffering to have to wait 6-8 weeks and only then to know if the medicine is helping or not is gut wrenching!
These types of medications take so long to take effect because of how the brain works and how the medications are attempting to supplement neurotransmitters to the brain. Neurotransmitters are defined as chemicals that allow neurons to communicate in the body, and there are many of these neurotransmitters in the brain. There is Glutamate (think MSG) that excites the brain. There is GABA that calms the brain. Dopamine which fills a few roles including motor control, motivation, and feelings of reward. Norepinephrine increases alertness and attention. Serotonin has been linked to sleep, memory, and mood.
Most of the medications designed to correct chemical imbalances in the mind work on increasing the concentration of one or two of these neurotransmitters within the brain. Most of these neurotransmitters are active when they are in the synapses – think electric recharging battery hubs – between neurons. If the synapses are flooded with neurotransmitters then the neurotransmitters can impact the brain and its moods. Based on this it would seem that all we need to do is pop a tablet, and more transmitters save the day. I wish that was the case! Just like the US Government was created with built-in checks and balances, so are our bodies. When the body sees too much of something, let’s say serotonin, it can stop releasing its natural serotonin or blocking serotonin’s movement in the body. Why? Because the body was designed with precision, and it is trying to protect the brain from a serotonin overload. So, if it senses an excessive amount it will work to protect itself. This is one of the reasons that although someone starts taking these types of medications, they may only begin to see an effect take place after two weeks or even two months of therapy. The body needs to recalibrate. Only at that point can we properly evaluate the dose and medication to see if it’s a correct fit for the patient.
Herein lies the problem. Until a person overcomes their objections and seeks help, time has passed. Let’s say at least several months. They are distressed. Their family is suffering because of it. Their work. Then add in all the self-doubt, “I am such a loser, nothing can help me”. Then the patient takes their medication
religiously…two months elapse, they have been inconvenienced with some side effects but figure it’s worth it if they are going to start feeling better, but then they experience either no change or even begin feeling worse! It’s heartbreaking, but many times a patient may need to switch medications, adjust doses, or add on another medication. Most times they need to go through the same waiting time again. Each time a patient with low resilience experiences this, they become more convinced that they are the problem and beyond help. They don’t consider the possibility that the medicine is inappropriate for them. Instead of seeing the failed attempt as the medication’s failure, they view it as their own. And unfortunately these thoughts of hopelessness can lead to suicidal notions.
Short of having a crystal ball, knowing how a medication would interact with our health prior to taking it, used to be impossible. I say “used to” because now we actually have the technology. But, despite having the technology and its cost no longer being prohibitive, we are still dispensing medication like we did in the ‘50s. Instead of picking the right medication that is optimal for the patient, our current mode of medical care tells the patient that they need to adapt to the medication. It’s absurd! One day in the not-so-distant future, patients will come into the pharmacy with a diagnosis from their doctor and the pharmacist will whip up a medication to match their personal genetics! But in the meantime, what can someone do to minimize their side effects, achieve quicker and more precise results? It’s called pharmacogenomic testing.
Pharmacogenomics is the science of using genetics and pharmacology to figure out what medication is optimal for the patient. It falls under the vast umbrella of personalized medicine. Many times, when new technology or products are introduced to market, they become hyped as the be-all and end-all, that they will fix all the problems.
Unfortunately, this is not the case. Pharmacogenomics are one piece of the puzzle to figuring out how to heal and assist patients. A professional needs to evaluate the
pharmacogenomic results, the patient’s medical history, as well as lifestyle issues to build the best plan of action to move towards good health. Pharmacogenomic testing may only be another tool in our diagnostic toolbox, but it is an extraordinary one that allows us to pinpoint why a patient may be suffering from side effects from one medication, why another may not be getting pain relief from another medication, which medication will be the best fit for a cancer growth, or how to get them free of mental illness faster than ever before.
Using this test, whose cost has dropped considerably and in certain states is free for eligible patients on Medicaid, we can now streamline patients who are suffering with mental illness on the first attempt! I can’t explain to you the difference this speed of outcome makes in the life of a patient. It means that they start to feel hope! It begins the process for their entire family to feel relief and return to feeling whole.
Another incredible perk is that it is not a blood test. It’s a painless saliva test that since it’s dealing with genetics may need to be done only once in a patient’s life. I stress “may” because to date there are genes that have been proven to be critical based on scientific research whereas others have not yet. This means that testing done now may only highlight genes that have been proven critical today, but in the future more genes may be determined to be significant, warranting another test.
To summarize, mental health medications take longer to see effects from because of the place of action and how the body responds to them. One of the easiest ways to streamline the response time is through pharmacogenomic testing. Removing the stigma from mental health is unquestionably critical to increasing the number of people seeking and getting help. But we also need to move forward and take steps to improve our own mental health. We need to improve our resilience to trauma, sleep more than seven hours a night, find time for self-care, eat foods that support our health, and if need be, invest in our health by using the many breakthroughs that are now available to us, such as pharmacogenomics.
Despite having the technology and its cost no longer being prohibitive, we are still dispensing medication like we did in the ‘50s.
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