A 59-year-old woman presented with a long history of depression, PTSD, and anxiety, and had been struggling with ongoing medication adjustments that left her feeling worse instead of better. At the time of her initial visit, she was taking Lamictal (150 mg daily), Caplyta (21 mg daily), and Auvelity (twice daily). Despite these prescriptions, she continued to experience worsening anxiety, irritability, insomnia, and suicidal thoughts.
To better understand her individual biochemical profile, genetic testing (Genomind) was performed. The results revealed two key findings:
- Intermediate MTHFR activity (one C and one T allele), suggesting reduced ability to convert folate into its active form.
- Intermediate CYP2B6 activity, indicating slower metabolism and accumulation of Wellbutrin, one of the components of Auvelity.
These insights provided a clear clinical direction. The patient was advised to discontinue Auvelity and begin L-methylfolate (400 mcg daily) to support methylation and neurotransmitter synthesis. Within a week, she reported significant improvement—she was sleeping through the night, no longer felt anxious or irritable, and her suicidal thoughts had completely resolved.
At her follow-up visit, she noted continued fatigue with Caplyta, so it was discontinued. Her current treatment plan includes Lamictal, L-methylfolate, omega-3 fatty acids, and vitamin D supplementation, with continued close monitoring.
This case illustrates how pharmacogenomic testing and nutritional interventions can help clinicians identify medication mismatches and provide more effective, personalized treatment strategies for complex psychiatric presentations.
