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Pharmacogenetic Testing for OCD Medications
Pharmacogenetic Testing for OCD Medications
Understanding OCD and Its Treatment Challenges
Obsessive-compulsive disorder (OCD) often starts prior to adulthood, and typically involves repetitive, distracting thoughts, urges and desires to take specific actions. Many can feel anxiety or stress as a result.
Choice of treatment is usually made by the prescriber with input from the individual being treated. Treatment plans can include cognitive-behavioural therapy using exposure and response prevention and/or medication.
Treatments don't usually work right away. In the case of medications, usually much of the benefit tends to be seen after about 6 weeks. This is an ideal case, however, and multiple medications may need to be tried in sequence for several weeks at a time each. Effectiveness, side effects, or the balance of both, can be reasons for needing to switch to a different treatment. This process can be time consuming and frustrating.
Types of OCD Medications and Genetic Factors
Medications used for OCD commonly include serotonin reuptake inhibitors (SSRIs) like citalopram, other antidepressants clomipramine and venlafaxine, and certain antipsychotics including aripiprazole and risperidone. Medication decisions also include consideration for co-occurring mental health concerns, in part because some OCD treatment medications can produce additional relevant benefits.
OCD medication with the least side effects or better effectiveness can often be specific to an individual. Effectiveness and side effects are influenced by several factors. This can include the specifics of the diagnosis, the health and functioning of an individual's liver and kidneys, interactions with other medications, medical history, pregnancy and genetic factors. Genetic factors relate to the way OCD medications are processed (or metabolized) by the body and be a reason two seemingly similar individuals being treated for OCD may respond different to the same medication and dose. This does not answer broader questions about OCD genetic factors (e.g., "is my OCD hereditary?").
Using Pharmacogenetic Testing Results to Guide OCD Treatment
OCD pharmacogenetic testing identifies genetic variations in key genes responsible for metabolizing many OCD medications, ideally before they are taken. These variations can result in reduced functioning of these enzymes, which can result in accumulation of these medications as they aren't being cleared from the body as hoped. This accumulation means the medications are "over-staying their welcome" when it's time for the next dose to be taken. As a result, side effects become more likely, or are worse than would otherwise be seen. On the other hand, in some individuals, the opposite can happen. Due to other genetic variants that cause over-functioning of these metabolizing enzymes, the medication is cleared too rapidly from the body. This means that they don't have enough time to exert their effects and help control symptoms as would be expected. There are sometimes exceptions - sometimes, slower metabolism can reduce effectiveness (because the medication could rely on byproducts formed by the body).
By using knowledge of this information, prescriber decisions to use the medication (per usual or with modified dosing) or consider alternatives can be enhanced and may result in less trial-and-error and a quicker path to feeling better.
Is Pharmacogenetic Testing Right for Your OCD Management?
Pharmacogenetic testing may be helpful if you are at the early stages of treatment with medication, helping inform your health care provider's choices from the start. It can also be helpful if you have previously found that certain medications did not work well and/or caused difficult side effects.
