Pharmacogenetics: prescribing antidepressants with genetic precision

A new spin-off company has been launched thanks to ground-breaking research from a Deakin team.

Professor Ajeet Singh had an idea to refine the treatment of mental health disorders, taking it from treating the condition to the individual person.  

Recent Census data has revealed that over 2.2 million Australians have a diagnosed mental health issue, surpassing other chronic health issues such as arthritis and asthma. In the aftermath of the pandemic, stress-related illnesses such as depression have escalated.

“The genomic space has, for a long time, been a great frontier with much promise that hasn’t delivered,” Prof. Singh says. There have been several technologies that have oversold, overpromised and under-delivered in this area. However, Prof. Singh and his team bring a unique perspective to the table. 

Prof. Singh is a consultant Psychiatrist at The Geelong Clinic who blends the worlds of genetics and pharmaceuticals into his research at Deakin’s School of Medicine. He describes himself as an ‘academic private Psychiatrist’ – trying to bridge the translational gap between medical research and clinically meaningful innovations in care.

This is where Prof. Singh’s idea for CNSDose emerged – after seeing the side effects and adverse reactions of his own patients, he wanted to create better outcomes for them by exploring genetically guided prescribing, also known as pharmacogenetics. 

As it takes about a month to gauge if an antidepressant at a particular dose is helping, patients can endure months to years of trial and error to find an effective tolerable medication – often becoming demoralised during this drawn-out process. 

Thanks to funding from the Melbourne Accelerator Program (MAP) and Texas Medical Centre Venture Fund he’s been able to translate his ideas into reality. 

Its aim is simple – to reduce the trial and error in prescribing anti-depressants.  

So, how does it work? Patients give a saliva sample to their doctor; a lab analyses the genes involved and assesses how easy or hard it is for certain antidepressant medications to reach that person’s brain. 

The CNSDose edge combines hepatic (liver) genetic profile with blood-brain-barrier (BBB) genetic profile to stratify patients into low, medium, or high dose for optimal central nervous system (CNS) bioavailability – enhancing efficacy and tolerability. Prof. Singh led a group that published initial clinical trial results in 2015 with replication in 2017 showing the medication guidance report improve treatment outcomes.

“Based on that, we receive guidance on over 20 different antidepressants and whether they need to be a high, medium or low dose for that patient,” Prof. Singh says. 

Dr Ajeet Singh

“A great deal of prescribing in psychiatry is trial and error, and I wanted to tackle that with a technology that is affordable.”

– Professor Ajeet Singh

Earlier this year CNSDose was acquired by an Australian diagnostics firm. The test is now available locally in Australia and an $800K grant from the Ramsay Foundation has now allowed the team to go one step further with the CNSDose Study.

They are now conducting an 800-person randomised control trial which is a fully independent replication study. They aim to help clinicians to select optimal first-time treatment options for various psychotropic medications to give patients better results, reduce the risks of adverse medical reactions, and reduce the length of time in hospital among patients with severe depression.

Not only does the concept of genetically guided prescribing improve the lives of patients, but there are also increasing advantages to governments and healthcare systems. There were 42.7 million prescriptions filled for mental health-related medications (both subsidised and under co-payment) in Australia in 2020–21. Reduced trial and error stand to cut wastage, and also reduce the time patients spend unwell – which has significant health and economic ramifications for society.

“I would describe myself as an accidental entrepreneur,” he says. “Because I am a clinician, I didn’t have much experience in what I still call the ‘business world’. Since being acquired earlier this year we now have an adept, well-resourced execution team, with plans to ramp up global sales in 2023.” 

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