Not Every Struggle Is Visible — and Not Every Treatment Works the Same Way
pro Genome
Understanding the role of pharmacogenomics and nutrigenomics in mental healthcare
Every year on 10 September, World Suicide Prevention Day reminds us that suicide prevention begins by changing how we respond to emotional pain.
The theme for 2024–2026, “Changing the Narrative on Suicide,” calls for a shift away from silence, stigma and judgment towards openness, understanding and support.
That change can begin with something simple:
Instead of asking, “Why can’t you just be grateful?”, we can ask, “What are you going through?”
Instead of assuming that someone is not trying hard enough, we can recognise that depression is a health condition influenced by many interconnected factors—including biology, life experiences, relationships, physical health, environment and access to support.
Treatment is equally complex. What works well for one person may be less effective or less tolerable for another. Genetics may help explain one part of this difference, but it never tells the whole story.
Why can the same antidepressant affect people differently?
When someone begins an antidepressant, the treatment journey may involve adjustment.
One person may respond well to the first medicine prescribed. Another may experience troublesome adverse effects. Someone else may require a different dosage or medicine before achieving an acceptable balance between improvement and tolerability.
These differences can be influenced by many factors, including:
- The underlying diagnosis and severity of symptoms
- Age, liver and kidney function
- Other medicines or supplements being taken
- Previous treatment response
- Adherence and duration of treatment
- Alcohol, smoking and substance use
- Psychological and social circumstances
- Genetic differences affecting drug metabolism
This is where pharmacogenomics, or PGx, may contribute useful information.
How pharmacogenomics may support antidepressant treatment
Pharmacogenomics examines how variations in our genes may influence the way our bodies respond to certain medicines.
Some antidepressants are metabolised by enzymes produced from genes such as CYP2C19 and CYP2D6. Genetic variations may cause the activity of these enzymes to differ between individuals.
For certain medicines, a person who metabolises the drug more slowly may experience higher drug exposure at a standard dosage. Another person may process it more rapidly, potentially resulting in lower exposure. However, the clinical effect depends on the specific medicine and the individual’s overall health circumstances.
Clinical pharmacogenomic guidance is available for selected antidepressants, including certain drug-gene relationships involving:
- Citalopram, escitalopram and sertraline with CYP2C19
- Paroxetine, venlafaxine and vortioxetine with CYP2D6
- Sertraline with CYP2B6
The Clinical Pharmacogenetics Implementation Consortium (CPIC) provides recommendations on how existing genetic results may help inform the prescribing of these medicines. However, it also stresses that pharmacogenomic information is only one of many factors that must be considered.
A pro.Genome Pharmacogenomics report may therefore support a more informed discussion between the patient and healthcare professional about medicine selection, dosage or monitoring where an actionable drug-gene relationship is present.
It should not be interpreted as a simple list of “good” or “bad” medicines.
What pharmacogenomics cannot tell us
The limitations are particularly important when discussing mental health and suicide prevention.
A pharmacogenomic test:
- Does not diagnose depression or another mental health condition
- Does not determine how severe someone’s depression is
- Does not predict whether someone will attempt suicide
- Does not guarantee that a particular antidepressant will work
- Does not replace a psychiatrist, doctor, pharmacist or counsellor
- Should not be used independently to start, stop or change treatment
Pharmacogenomics mainly helps us understand selected aspects of medication response, particularly drug metabolism and exposure. It cannot fully account for someone’s lived experiences, emotional environment, relationships or current safety.
Anyone taking an antidepressant should continue the medicine as prescribed unless the prescriber advises otherwise. Sudden changes or discontinuation may cause withdrawal symptoms or deterioration of the condition.
Where does nutrigenomics fit?
Nutrition is another area frequently discussed in relation to mental wellbeing.
The pro.Genome Nutrigenomics report includes genetic insights related to nutrients such as:
- Vitamin B9 or folate
- Vitamin D
- Omega-3 fatty acids, including EPA and DHA
These nutrients contribute to many normal biological processes. Nutrigenomics may identify inherited tendencies related to how the body processes, utilises or maintains certain nutrients.
However, a genetic tendency is not the same as a current nutritional deficiency.
For example, an increased genetic susceptibility to lower vitamin D status does not confirm that a person is vitamin D deficient today. Current status may still be influenced by diet, sunlight exposure, health conditions, medicines and lifestyle. Where appropriate, clinical assessment and laboratory testing are needed.
Nutrigenomic findings should therefore be interpreted together with:
- Dietary intake
- Relevant symptoms
- Medical history
- Current medicines and supplements
- Laboratory results where clinically appropriate
- Advice from a qualified healthcare professional
Nutrition may form part of a broader wellbeing plan, but supplements are not a substitute for psychological support, medical assessment or evidence-based mental health treatment. A person experiencing suicidal thoughts needs immediate human and professional support—not a DNA test or supplement recommendation.
Personalised care means seeing the whole person
The real value of personalised healthcare is not simply collecting more data. It is using relevant information responsibly while continuing to see the individual behind the results.
A more complete approach to mental healthcare may include:
- A proper medical and mental health assessment
- Psychological or counselling support
- Appropriate medication when indicated
- Review of previous treatment response and adverse effects
- Pharmacogenomic information for selected medicines
- Nutritional and laboratory assessment where relevant
- Sleep, physical activity and lifestyle support
- Regular follow-up and safety monitoring
- Support from family, friends and the wider community
Genetic information may make one part of this care more informed. It should never reduce a person to a set of genetic variants.
Sometimes, the most important intervention is human connection
If someone tells you that they are struggling, you do not need to have all the answers.
Listen without judgment. Take what they say seriously. Stay connected and help them reach appropriate support.
A genetic report can provide health information, but it cannot listen to someone’s pain, sit beside them during a difficult moment or help them reach emergency care.
People do that.
This World Suicide Prevention Day, let us remember:
DNA may guide one part of treatment. Human connection remains at the heart of suicide prevention.
If you or someone you know needs help
For emotional distress or suicidal thoughts in Malaysia:
Talian HEAL: 15555
Befrienders Kuala Lumpur: 03-7627 2929
Free, confidential emotional support, available 24 hours daily.
If there is an immediate risk of harm, call 999 or proceed to the nearest hospital Emergency Department.
This article is intended for general education and awareness. Pharmacogenomic and nutrigenomic results should be interpreted with a qualified healthcare professional. Do not change any prescribed medicine or begin high-dose supplementation based solely on genetic test results.
