Precision medicine is the future of modern psychiatry. At Psychiatry Redefined, we’ve already been training health-care providers in a precision, whole-person treatment approach – far more effective for patients than standard, one-size-fits-all medication strategies.
And while mainstream precision medicine for mental health (or precision psychiatry) currently focuses solely on genetic markers related to drug metabolism, other genetic assessments can also provide valuable insights. A recent study examining a well-established genetic risk factor for mental illness in relation to the use of low-dose lithium highlights the benefits (Dickerson 2023).
Low-Dose Lithium for Depression and Anxiety
The current study focused on the use of low-dose lithium for the treatment of both depression and anxiety, dosing just under standard therapeutic levels. Normal lithium dosing for bipolar disorder is between 600 and 1800 mg of lithium carbonate a day, adjusted by blood levels. In the present study, low-dose lithium was defined as dosing between 300 and 600 mg (57-104 mg of elemental lithium) with the majority of included patients taking what would be considered a subtherapeutic, 300 mg dose.
CACNA1C Single Nucleotide Polymorphisms
Along with taking low-dose lithium, only patients with depression or anxiety diagnoses who also had a specific genetic marker were included. The genetic marker consisted of a single nucleotide polymorphisms (SNPs) of the calcium voltage-gated channel alpha-1c (CACNA1C) at position 2,236,129. This SNP of the CACNA1C gene has long been significantly associated with mental illness, including bipolar disorder, schizophrenia, major depression and anxiety (Moon 2018). The SNP was either present on one (heterozygous) or both (homozygous) genes, with a substitution of adenine (A) for guanine (G).
Upon chart review, patients who had CACNA1C SNPs that were prescribed low-dose lithium had their depression symptoms decreased 66% and anxiety symptoms decreased 65% on average. Statistically, low-dose lithium treatment resulted in large improvements in both mood and anxiety in patients with CACNA1C SNPs.
Since the study was an observational chart review, it lacked both a placebo arm and a comparison group of patients lacking the CACNA1C SNP. Yet it still lays a foundation for further exploration. Of note, depending on a patient’s ethnicity, CACNA1C SNPs are present in between 11% and 70% of individuals. The CACNA1C SNP is common, and may be a marker that can help establish who will respond to low-dose lithium as a potential treatment.
Precision Medicine Training for Mental Health
The use of genetic markers to identify more effective treatment options is laying the foundation for advances in precision psychiatry. At Psychiatry Redefined, we’ve been teaching numerous aspects of precision psychiatry for years: assessing biochemical and genetic markers to provide patients with more effective and personalized treatment.
If you want to transform your mental health practice and learn more about a personalized treatment approach for your patients, consider joining our Integrative Psychiatry Fellowship to learn the fundamentals of functional and integrative medicine, and precision psychiatry.
Our Fellowship covers nine critical subject areas, including genetic testing and nutritional supplementation. The curriculum lays a solid foundation in precision and functional medicine, while giving you an advanced clinical tool kit for treating mental health symptoms. Plus, you get access to the Psychiatry Redefined private community where you’ll find a robust forum to discuss cases and treatments with community mentors, peers and faculty.
Dr. Madrigal, a previous fellow, described her own experience: “I feel more confident that I’m offering my patients a better approach, the best really, and I can make my approach more scientific and accurate.”
If you want to learn the latest functional interventions to use with your patients, join our next Fellowship session starting January 2024.
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Dickerson MR, Reed J. Pharmacogenetic testing may benefit people receiving low-dose lithium in clinical practice [published online ahead of print, 2023 Oct 26]. J Am Assoc Nurse Pract. 2023;10.1097/JXX.0000000000000968. doi:10.1097/JXX.0000000000000968
Moon AL, Haan N, Wilkinson LS, Thomas KL, Hall J. CACNA1C: Association With Psychiatric Disorders, Behavior, and Neurogenesis. Schizophr Bull. 2018;44(5):958-965. doi:10.1093/schbul/sby096