The authors’ observations
In a complementary case, the author (JGW) consulted on a patient who was taking paroxetine and experiencing anorgasmia, weight gain, and loss of libido. Pharmacogenomic testing revealed that the patient was a poor metabolizer of CYP2D6. Paroxetine is substantially metabolized by CYP2D6; therefore, it was likely that high blood levels were contributing to the side effects.3,7 The key clinical distinction is that although this patient was bothered by intrusive side effects, he was not fixated on them like Mrs. C. His pharmacogenomic test results were used to identify a metabolic issue that was causing the side effects. This is in contrast with Mrs. C, for whom the pharmacogenomic information ruled out a metabolic issue as the primary problem and helped guide the next step in treatment.
Mrs. C’s case illustrates how pharmacogenomics and ACT complemented each other to create a desirable outcome. Pharmacogenomic testing originally was developed as a safety mechanism for medication choice and dosing, but clinical applications have grown as astute clinicians utilize it to help care for their patients.8 ACT can be a powerful tool for patients who have difficulties creating distance from their thoughts. Both pharmacogenomic testing and ACT are noninvasive interventions that can be implemented as part of a multi-faceted treatment approach.
Related Resources
- Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: The process and practice of mindful change. 2nd ed. New York, NY: The Guilford Press; 2011.
- Mrazek DA. Psychiatric pharmacogenomics. New York, NY: Oxford University Press; 2010.
Drug Brand Names
- Amitriptyline • Elavil
- Aripiprazole • Abilify
- Bupropion • Wellbutrin, Zyban
- Citalopram • Celexa
- Clomipramine • Anafranil
- Clozapine • Clozaril
- Desipramine • Norpramin
- Diazepam • Valium
- Doxepin • Adapin, Silenor
- Duloxetine • Cymbalta
- Escitalopram • Lexapro
- Fluoxetine • Prozac
- Fluvoxamine • Luvox
- Haloperidol • Haldol
- Imipramine • Tofranil
- Lithium • Eskalith, Lithobid
- Mirtazapine • Remeron
- Olanzapine • Zyprexa
- Nortriptyline • Pamelor
- Paroxetine • Paxil
- Perphenazine • Trilafon
- Quetiapine • Seroquel
- Risperidone • Risperdal
- Sertraline • Zoloft
- Trazodone • Desyrel, Oleptro
- Venlafaxine • Effexor
- Ziprasidone • Geodon
Disclosure
The authors are employed by AssureRx Health, Inc., the provider of the pharmacogenomic testing used in this article.