The importance of the genetic profile for the pharmacological treatment of anxiety disorder.

Anxiety is one of the main psychiatric disorders affecting the population. According to the World Health Organization (WHO), 1 in 13 people worldwide suffers from anxiety. Even though treatment for anxiety is effective, only part of the population receives this treatment, and the path to finding the most suitable one can be arduous. Pharmacogenetics assesses individual response based on the analysis of variants in the most frequent genes associated with the metabolism of drugs used in the treatment of anxiety, enabling the choice of a more assertive, effective and safer treatment for the patient.  

 

What is anxiety?

Anxiety is characterized as an excessive and uncontrollable concern about certain situations, even in the absence of the respective stimuli or even in a way that is disproportionate to the risk presented. 

Anxiety can also occur in conjunction with depression. According to the Anxiety and Depression Association of America, nearly half of individuals diagnosed with depression also suffer from anxiety. There are several types of anxiety disorders, the main ones being generalized anxiety disorder, panic disorder, and several phobia-related disorders.

 

What are the types of anxiety and their symptoms?

Generalized Anxiety Disorder (GAD): Individuals are overly concerned on most days, for at least 6 months, about everyday circumstances such as personal health, work, and social interactions. It is the most common anxiety disorder among older adults; however, these cases are often associated with traumatic events.

The most common symptoms of generalized anxiety disorder include:

  • Restlessness, tension or nervousness
  • Tiredness
  • Difficulty concentrating 
  • Irritability
  • Muscle tension
  • Insomnia

Panic Disorder: Individuals with panic disorder have recurrent panic attacks. Panic attacks are sudden periods of fear that reach their peak within a few minutes and may occur unexpectedly or due to some trigger. 

Symptoms during a panic attack are the following:

  • Tachycardia
  • Sweating
  • Tremors 
  • Feelings of shortness of breath, suffocation or asphyxia
  • Feelings of imminent danger
  • Feelings of being out of control

People with panic disorder often worry about the next attack and actively try to prevent it by avoiding places, situations, or behaviors that they associate with panic attacks. This concern with future panic attacks can result in the development of agoraphobia. 

Phobia-Related Disorders: A phobia is an intense fear or aversion to specific objects or situations, such as flying, heights and animals. 

Even though it is common to be anxious in some situations, individuals with phobia have an exaggerated anxiety about the real danger caused by the situation or by the object.

Individuals with phobia show excessive concern/anxiety in finding the feared object or situation, an attitude to avoid the feared object or situation, and resistance to unavoidable objects and situations with intense anxiety.

Social Anxiety Disorder: Individuals with social anxiety disorder have intense fear or anxiety about social situations or performance. Individuals are afraid that the actions or behaviors associated with their anxiety will be negatively evaluated by other individuals, leading them to avoid social situations. 

Agoraphobia: Individuals with this condition have an intense fear of two or more of the following situations:

  • Using public transportation
  • Being in open spaces
  • Being in enclosed spaces
  • Being in crowds
  • Being outside home alone

In the most severe form of agoraphobia, individuals may be confined to their home.

Separation Anxiety Disorder: Usually associated with children only. However, adults can also be diagnosed with separation anxiety disorder. Individuals are afraid of separating from other individuals they are attached to. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. 

 

Treatments for Anxiety Disorders

Anxiety disorders are highly treatable. They are usually treated with psychotherapy, medication or both, the best treatment being indicated by the responsible specialist. Despite being a treatable disorder, only 36.9% of individuals who suffer from anxiety receive treatment.

Drug treatment:

Drug treatment for anxiety is generally safe and effective and is usually used in conjunction with psychotherapy. 

Four main classes of medications are used to treat anxiety disorders:

  • Selective Serotonin Reuptake Inhibitors (SSRIs) – SSRIs improve symptoms by blocking the reuptake or resorption of serotonin by nerve cells in the brain, increasing the level of serotonin available. 
  • Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs) – SNRIs promote increased levels of serotonin and noradrenaline by inhibiting the reuptake of brain cells. 
  • Benzodiazepines: They are generally used for short-term control of anxiety and as a supplement in cases of resistance to treatment. Benzodiazepines are highly effective in promoting relaxation and reducing muscle tension and other physical symptoms of anxiety. Long-term use may require larger doses to achieve the same effect, which can lead to problems related to tolerance and dependence.
  • Tricyclic Antidepressants: Concern about the long-term use of benzodiazepines has led many physicians to prefer tricyclic antidepressants (inhibition of reuptake of monoamines, mainly norepinephrine, serotonin, and dopamine). 

However, finding an effective treatment for anxiety can be a hard work. However, finding an effective treatment for anxiety can be hard work, as different drugs and doses are often tried until finding the treatment that really helps the patientPharmacogenetics for Anxiety

Several genes act on the expression of cytochrome P450 enzymes, which is the main metabolizer of drugs. Thus, variants in these genes can result in a diverse response to drugs. Pharmacogenetics aims to assess the influence of genes on individual responses to drug products.

 

About the SYNLAB FG Neuro Anxiety Exam

In order to assist in the assertiveness and individualization of pharmacological treatment for anxiety, SYNLAB offers the FG Neuro Anxiety examination, which studies genetic variants in the main genes (CYP3A4, CYP3A5, and CYP2C19) involved in the expression of metabolizing enzymes that are related to effect and toxicity of the 13 most used drugs for the treatment of anxiety:

  • Alprazolam
  • Bromazepam
  • Clobazam
  • Clorazepate
  • Chlordiazepoxide
  • Diazepam
  • Doxepin
  • Flunitrazepam
  • Ketazolam
  • Lormetazepam
  • Triazolam
  • Zolpiden
  • Zopiclone

 

What is the methodology used to perform the exam?

The SYNLAB FG Neuro Anxiety exam is performed by Next Generation Sequencing (NGS), providing greater flexibility in the process, high yield and greater sensitivity of the analysis (99%). 

 

What benefits can the FG – Neuro Anxiety exam offer?

Through the analysis of variants in the main genes involved in the expression of drug metabolizing enzymes, it is possible to classify the metabolism for each drug analyzed, with the objective of helping the prescribing physician in a more effective treatment and with a lower risk of side effects, enabling a more assertive treatment in less time.  

 

For whom is it indicated?

The FG Neuro Anxiety exam offered by SYNLAB is indicated for:

  • Patients undergoing pharmacological treatment who wish to personalize their medication based on their genetic profile.
  • Patients with side effects to the drugs.
  • Patients in whom pharmacological treatments do not provide the expected results.
  • Patients who are going to start a pharmacological treatment

 

Other pharmacogenetics testing offered by SYNLAB

SYNLAB has a wide availability of pharmacogenetic tests. Learn more in our article Pharmacogenetics: Influence of genetic variants on drug metabolism

 

About the SYNLAB Group

The SYNLAB Group is a leader in providing medical diagnostic services in Europe, providing a full range of clinical laboratory analysis services to patients, healthcare professionals, clinics and the pharmaceutical industry. Resulting from the Labco and SYNLAB merger, the new SYNLAB Group is the undisputed European leader in medical laboratory services.

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