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Personalized Medicine and Psychoanalysis ISSN: 2572-4037 Serani et al. Int J Psychol Psychoanal 2019, 5:041 DOI: 10.23937/2572-4037.1510041 Volume 5 | Issue 1 International Journal of Open Access Psychology and Psychoanalysis REVIEW ARTICLE Personalized Medicine and Psychoanalysis: How Pharmacogenomic Testing Facilitates Depression Treatment Deborah Serani* Check for updates Derner Institute of Advanced Psychological Studies, Adelphi University, USA *Corresponding author: Deborah Serani, Psy.D., Derner Institute of Advanced Psychological Studies, Adelphi University, 12 Ivy Hill Drive, Smithtown, New York, 11787, USA, Tel: 631-366-4674 as the identification of how one’s genes metabolize Abstract and process antidepressant, psychotropic and other Pharmacogenomic testing offers enormous potential to man- medications in the body [2,3]. age mental disorders like depression. But many psychoana- lysts aren’t aware of its value and biotechnical power. This Personalized Medicine article explains how this form of personalized medicine can be used to aid in the treatment of patients with depression. The traditional way of prescribing medicine has al- With over 20 medications approved by the FDA to treat de- ways been based on the likelihood that each drug will pression, and many others recommended for off-label use, treatment failure with antidepressants commonly occurs in work equally well in the entire population. Dose adjust- clinical practice. Inviting genetic testing into the treatment ments are based on physical variations, such as height plan when working with depressed patients can reduce the and weight, with most drug manufacturers offering a rate of medication failure, improve antidepressant compli- “one size fits all” approach. The new way of prescribing ance and more accurately address resistance in analysis. medicine - once considered science fiction - is having Keywords tailor made medicines for each person. And it’s avail- Antidepressants, Cytochrome p450, Depression, Genetic able now. Pharmacogenomic testing is more casually testing, Medication, Personalized medicine, Pharmacog- known as personalized medicine or precision medicine enomics, Psychoanalysis, Treatment resistant depression and refers to the use of genetic testing to improve the safety, effectiveness, and health outcomes of patients taking medication [4,5]. Introduction Pharmacogenomic testing offers enormous poten- In 2003, the human genome was sequenced success- tial to manage diseases and illnesses like depression. But fully, bringing with it new discoveries, insights and sci- many therapists aren’t aware of its value and biotechni- entific technologies. The Human Genome Project was a cal power. Some clinicians have never heard of the term feat unto itself, cracking open the door toward a deep- Cytochrome p450 or that a genetic test can determine er understanding of genes and environment [1]. When target-specific medications for patients. Others might reading about it, I wondered, “How could this science be familiar with genetic testing, but mistakenly believe help mental illness?” I thought further, suspecting it’d it’s pricey. Or don’t know it’s fully covered by Medicare be decades before mental illness and genetics would and insurance companies. Others practitioners aren’t get time under the microscope. aware of the various genetic panels offered, what they do and how to interpret the results [6]. Additionally, In truth, it took less than a decade for genetics to studies suggest the general public has varying genetic root itself in a very important niche in mental health. The literacy about the usefulness of tests, and as such, don’t pharmacogenomics specific science, called , is defined utilize this biotechnology to advance their health [6]. Citation: Serani D (2019) Personalized Medicine and Psychoanalysis: How Pharmacogenomic Test- ing Facilitates Depression Treatment. Int J Psychol Psychoanal 5:041. doi.org/10.23937/2572- 4037.1510041 Accepted: June 12, 2019: Published: June 14, 2019 Copyright: © 2019 Serani D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Serani et al. Int J Psychol Psychoanal 2019, 5:041 • Page 1 of 7 • DOI: 10.23937/2572-4037.1510041 ISSN: 2572-4037 Regardless of the reasons why pharmacogenom- pressed patients and found no obstructions in the ana- ics is still not well known, Cytochrome p450 testing lytic frame. Freud further expressed that using medica- needs more clinical application. Its utility is enormously tion appeared to maintain analysis when her patients’ far-reaching for our patients and for our work as psy- untreated symptoms might otherwise have required choanalysts. hospitalization [13]. The medication boon of the 1990’s and 2000’s led to a plethora of studies showing how Psychoanalysis and Medication medication combined with psychotherapy was a viable Sigmund Freud, a neurologist by training, hypothe- evidenced-based treatment for many psychological dis- sized neurons were pathways of excitations responsible orders [16]. And while there are some who still hesitate for psychological experiences. In fact, Freud’s “Project to use medication in psychoanalysts, most analysts have for a Scientific Psychology” [7] reflected his vision by evolved with the research, broadening their knowledge detailing how psychic phenomena in neurobiological of pharmacotherapy. terms included affect, consciousness, dreaming, mem- As psychoanalysts, we believe mental disorders are ory, perceptions, self and symptom formation, just to the result of traumas and stressors inherent in the hu- name a few [8]. Freud [7] also believed that hormones man condition. More specifically, we deem the struc- in the brain influenced emotional and mental life, but ture of symptoms can be traced to maladaptive defen- was unsure of the specifics of their functioning. While sive operations and relational and attachment setbacks. Freud lacked the technology to further test his theories, Though we treat many patients without the use of med- he anticipated future discoveries in neurobiology and chemical properties would advance psychoanalysis [9]. ication, we need to advance our awareness of genetic testing for patients who need medication. While there And Freud was right. Modern scientific testing in the is no current research or case studies on the use person- form of fMRIs, PET scans and EEGs have validated many alized medicine and psychoanalysis, Frank [17] reminds of his concepts. For example, Julius Axelrod [10] dis- us how the next wave of significant change in psycho- covered the neuronal-synaptic function of neurotrans- analysis will involve greater integration of nonanalytic mitters of norepinephrine, epinephrine, and dopamine approaches. And this next wave, I believe, is personal- in the brain. And the role of additional neurotransmit- ized medicine. ters soon followed, including acetylcholine, serotonin, GABA, glutamate, orexin, and other neuropeptides [11]. Treating Depression While many neurobiological discoveries regarding brain Major depressive disorder (MDD) is one of the most and behavior have occurred, history shows that psycho- common mental illnesses in the United States. Accord- analysts have been, at best, cautious about combining ing to the Center for Behavioral Health Statistics and medication with psychoanalysis [12]. Quality [18] the Substance Abuse and Mental Health In the late 1950s, when psychotropic medications Services Administration national survey reported over were first developed, their use as an ancillary treatment 16 million adults or 6.7% of the adult population have was met with outright rejection by the psychoanalytic been diagnosed with depression. Depression also oc- community. Analysts believed the deep and curative curs in children, with 4% of preschoolers, 5% school work in psychoanalysis needed to remain undisturbed, aged children and 11.2% adolescents experiencing a di- so the use of medication was considered an intrusion agnosable depressive disorder [19]. When it comes to [13]. Some criticisms about inviting medication into MDD or Dysthymia, analysts use talk therapy to reduce the analytic treatment frame was that exploration of symptoms. As previously mentioned, for some of our unconscious patterns, resistances, transferences, and patients, psychotherapy alone will ease the symptoms other psychoanalytic concepts would be diluted or even of depression. But for many, the treatment plan will derailed when medication was introduced to treatment likely lead to a psychiatric consultation for medication. [14]. Others voiced concern how the need for the ana- lyst “to cure” the patient with medication might set up Pharmacotherapy treatment for depression regu- unexamined countertransference issues or activate res- lates neurobiology and the monoamine neurotransmit- cue enactments, or the goal of eliminating psychologi- ters serotonin (5HT), norepinephrine (NE), and dopa- cal pain through the use of pharmacotherapy might be mine (DA) in a series of neural circuits in the brain [20]. counterproductive for psychological growth [12]. While there are over 20 medications approved by the FDA to treat depression, and many others recommend- But not all analysts felt medication was a disruption ed for off-label use, treatment failure with antidepres- in the analytic frame [14,15]. When SSRI’s were being sants commonly occurs in clinical practice [21]. Studies introduced
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