Unlocking the genes influencing anxiety
Australian researchers are trying to understand what genes could increase a person’s risk of developing an anxiety disorder and how they might respond to treatment.
What if doctors could analyse your DNA to better understand your risk of developing anxiety and, more importantly, how best to treat it – or perhaps even avoid it from taking hold in the first place?
It’s a future Australian scientists hope is possible and, to try to prove it, they’re launching a study examining the genetic profile of people with an anxiety disorder and comparing it with people who have not experienced it.
“What we’re trying to do in this study is really understand more about what leads some people to experience anxiety; what the genetic and environmental risk factors are, but then also trying to work out how we can better treat anxiety,” said Professor Sarah Medland.
She is a researcher with the QIMR Berghofer Medical Research Institute and is leading the Living With Anxiety study in collaboration with the Brain and Mind Centre at the University of Sydney.
The exact cause of anxiety remains unclear, but it is understood a combination of genetic, environmental, and psychological factors contribute towards it.
This study will aim to collect data from around 5000 Australians with lived experience of anxiety to help identify the specific genes that could be influencing their condition.
A second phase of the study will explore the use of pharmacogenomic testing to try to predict individual responses to antidepressant medications.
“While psychological therapies are usually the first and most effective treatment option for these life-disrupting anxiety disorders, medication is also commonly prescribed. But finding the right medication can prove time-consuming and complex.
“We do know a few of the risk factors that can influence how well a medication works, but there’s going to be many more out there that need to be found, and one of the things we’re trying to do is really identify these to try and make some progress in that area,” Professor Medland said.
Anxiety is believed to affect 3.4 million Australians aged between 16 and 85 each year, representing the nation’s most common mental health condition. It is not only distressing to those who experience it, but is often associated with other conditions including depression.
According to the Royal Australian College of General Practitioners, since 2017 GPs have consistently reported the most common health issues they support patients to manage are psychological.
Leaving anxiety untreated can have devastating effects, especially if a person tries to self-manage it with unhealthy behaviour such as substance misuse.
Professor Ian Hickie is co-director of health and policy at The University of Sydney’s Brain and Mind Centre and is also involved in the study.
“About 20 per cent of people who start on any particular medicine give it away or have significant side effects because of difficulties in the treatment, and so don’t ever derive any benefit from the treatment,” he said.
“Now, if we were able to better predict who was likely to have an adverse effect in the first place and therefore make different choices in terms of treatment … we’d improve the matching of treatments to individual people.”
While strides have been made in understanding the role of genes in other areas of medicine, the same advancements have not been seen in mental health.
Professor Hickie wants that to change, and not just for mood disorders. It’s an issue he and Professor Medland have written about in the most recent edition of MJA InSight+ newsletter, published by the Medical Journal of Australia.
“As the position statement from the Royal College of Pathologists of Australia notes, pharmacogenomics guidance is included on more than 15 per cent of medications in the US, (but) there is little evidence these developments are being included in Australian healthcare,” they write.
“A 2019 retrospective analysis of 52,000 individuals from the Estonian Biobank found that of those who had been prescribed an antidepressant, up to 65 per cent had genotypes that meant they were likely non-responders. As such, they might have received an alternate medication or dosage if pharmacogenomics-informed prescribing had been implemented. These results highlight the impact that pharmacogenomics-informed prescribing may have if it were more widely adopted in Australia.”
Professor Hickie hopes studies like this one could help to change that by providing more scientific data about pharmacogenomics.
“We already under-utilise what we know about so-called pharmacogenomics, the extent to which genetics influences the way you metabolise drugs, and why we need to know why some people are fast to metabolise, or slow to metabolise, why some people respond more adversely (to medications),” he says.
“We’re already on the threshold of that, but it doesn’t have the same degree of sophistication yet as many other medical areas. The quicker we can do that with a large number of people, the quicker that will turn into information that will better inform what we do in the future in deciding the best treatment.”
The Living with Anxiety Study is being funded by the National Health and Medical Research Council. Participants will complete an online questionnaire about their personal experience and past treatments, medications and effects as well as other health and lifestyle factors. A second round of participants will then be invited to provide a saliva sample to enable DNA extraction and pharmacogenomic analysis.
More information can be found here.
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