Canadian HR Reporter

CANADIAN HR REPORTER OCTOBER 2019 22 FEATURES MENTAL HEALTH Combating the costly issue of chronic mental illness disability Mixing pharmacology with genomics can lead to better results in the workplace By Sanjida Ahmed H R often faces seemingly insurmountable chal- lenges where chronic mental illness is concerned. At least 15 per cent of Canadians in the workforce will suffer from mental illness during their life- times, according to a 2012 Mental Health Roundtable Report pro- duced by Statistics Canada and the Centre for Addiction and Mental Health (CAMH) in Toronto. Normally, this type of illness is treated using mental illness medi- cations (MIMs). But often, these medications don't work effectively and they have side effects. is means that many working Canadi- ans are likely to experience serious problems with their MIMs. ese can lead to reduced pro- ductivity, increased absenteeism, chronic mental health disabilities and even death. Combining genomics and pharmacology Fortunately, there is a solution — pharmacogenomics, the combin- ing of pharmacology with genom- ics. e pharmacogenomics field studies the role of the genome in drug response. e genome of an organism is the whole of its he- reditary information encoded in its DNA. More specifically, pharmacoge- nomics analyzes how the genetic makeup of an individual affects their response to drugs. Its goal is to find the right drug at the right dose for the right patient. But why is this goal so difficult to achieve? e answer is simple: Mental illness is a disease of the brain, by far the most complex or- gan in the human body. e brain regulates our actions, thoughts, memory, emotions and more. It does this through neurotransmit- ters — chemical substances that transmit nerve impulses across junctions to other nerves. Different neurotransmitters have different jobs and they work using "pathways." e cause of mental illness is the presence of abnormal levels of neurotransmit- ters in one or more pathways. e treatment is to prescribe mental illness medications that help cor- rect these abnormal neurotrans- mitter levels. Each MIM is designed to "tar- get" genes in a specific brain path- way, referred to as "receptors." But before arriving at their targets, these drugs must be metabolized correctly by another set of genes. Unfortunately, in an individual suffering from mental illness, these metabolic and receptor genes are abnormal because they have mutated. It is these mutations in the metabolic and receptor genes that result in the failure of mental ill- ness medications. Unfortunately, unlike blood sugar or cholesterol, mutations in genes cannot be tested using regular pathological tests. Because of this, physicians must resort to a trial-and-error process when prescribing MIMs. When medications fail Historically, these medications have generally failed between 40 and 50 per cent of the time, ac- cording to a 2016 European Col- lege of Neuropsychopharmacol- ogy study on why antidepressants don't work in some patients. And many people possess MIM genetic mutations that will com- plicate prescribing MIMs. is ex- plains why so many mental illness medications fail when they are first prescribed. Historica lly, pharmacoge- nomics owes its existence to an international scientific research undertaking (from 1990 to 2003) by the Human Genome Project (HGP). Its goal was to determine the sequence of base gene pairs that make up human DNA and to identify and map all the genes of the human genome from both a physical and functional standpoint. Today, the pharmacogenomics field offers a new perspective on preventing chronic mental illness disability. It has made possible ge- netically driven drug compatibility tests that can pinpoint mutations (abnormalities) in brain genes. is information can be used to identify which medications will work best for a patient, which are likely to be ineffective and which may cause serious side effects such as anxiety, heart pal- pitations or nausea. Pharmacogenomic testing can be integrated into modern men- tal health practices to help select psychotropic drugs — capable of affecting the mind, emotions and behaviours — for individu- als who have failed first-line evidence-based treatments, ac- cording to astudy by published by Cambridge University Press. is can yield better symptom- atic outcomes, better dosing and a reduced cost of treatment. Case study shows results Closer to home, a leading Cana- dian firm in the personalized pre- scription field recently carried out an anecdotal, observational study of 89 employees who took a pharmacogenomics test. All were on short-term disability due to depression, anxiety or other mental illnesses. The results included the following: • Almost all the employees had a significant number of mutated MIM genes that led to their be- coming disabled. • Following their pharmacoge- nomic analysis and subsequent personalized genetically driven drug compatibility report, these employees were prescribed cor- rect medications and dosages. • Most employees reported being very satisfied with the genetic test and confirmed that the change in mental illness medi- cations helped them return to work after a shorter period of time than originally expected. How, then, can HR leaders help those workers who will ex- perience serious problems with their mental illness medications? Make pharmacogenomics testing available to these employees after they have experienced MIM drug failures. e test can pinpoint the mutations in an employee or a de- pendant's MIM genes. As well, a pharmacist's recom- mendations accompanying a ge- netically driven drug compatibility report will assist the patient's phy- sician in identifying drugs to avoid and the best drugs to prescribe in terms of efficacy and side effects. As a corollary, HR has a re- sponsibility to investigate in- tegrating coverage for phar- macogenomic testing to help employees with mental illness to improve productivity, reduce absenteeism and avoid chronic mental health disabilities. Sanjida Ahmed is a geneticist at Per- sonalized Prescribing in Toronto. He can be reached at (647) 943-0210 ext: 263 or sanjida@personalizedprescrib- ing.com. For more information, visit www.personalizedprescribing.com. The largest conference of its kind, Cannexus brings together 1,200 professionals to exchange information and explore innovative approaches in career and talent development. "The value of Cannexus is the opportunity to obtain a pan-Canadian view of the employment service sector; to learn more about what is happening in all regions of Canada." – Heather McMillan, Executive Director, Durham Workforce Authority CHOOSE FROM 150 SESSIONS INCLUDING: • Career Development Discussions: A Tool for Increasing Engagement • Fitting into an Agile Workforce • Addressing Labour Needs for Persons with Disabilities • Helping Students Thrive in Post-Secondary and Career Transitions • Strategies to Welcome, Recruit & Retain Indigenous Talent • Predictors of Newcomer Employment Success: Evidence and Practice • Coaching iGen/Gen Z: Challenges, Opportunities and Strategies • Mid-Career Upskilling in a Digital Age REGISTER BY NOVEMBER 6 FOR EARLY BIRD RATES! Cannexus.ca MEDIA PARTNER: Centre Shaw Centre, Ottawa, Canada Januar y 27-29 janvier 2020 Zita Cobb Tristram Hooley Natan Obed

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