Discover the power of genetics


Mental Health

Second Generation Pharmacogenetics for Mental Health-related Conditions

Case Study: Rafaz Mohamed July – October 2020

Author: Sandra Hanna BSc. Pharm. Personalized Prescribing Inc.

Means of Referral: Organizational Solutions Inc. (OSI)

Disability status: Short term disability, was transferring to long term disability, which was approved by Sunlife Insurance

Condition(s): Major depressive disorder and Anxiety

Medications at point of contact: Escitalopram (Cipralex) 10 mg once daily, Mirtazepine 15 mg at bedtime

Side effects: fatigue, brain fog, nausea, sexual side effects


Upon referral by the OSI case manager, we promptly sent Rafaz our consent form, DNA kit by Purolator and I reached out for a phone appointment to discuss and document medication history.

Rafaz signed the consent form and returned the saliva sample by return Purolator. Rafaz’s sample was processed by our lab within 5 business days of receipt.

I analyzed his results and developed my recommendations which were converted into a PDF format and password protected.

I provided Rafaz with his results via email, sent him both the electronic report with information on his metabolism, response, and side-effect to the medication that we test for. I also sent him the personalized PDF report authored by myself with specific recommendations to taper and discontinue prior medications listed above, as well to initiate the new medication Levomilnacipran (Fetzima). The PDF report included a summary of Rafaz’ response to different medications, as well as a few paragraphs of rationale for his doctor. As per Rafaz’s consent, the report was faxed to his Doctor.

New medication: Levomilnacipran 20 mg once daily, titrated to effect (dose was stabilized at 40 mg)

Soon after, I scheduled another phone appointment, where I explained the results to Rafaz. Rafaz’s Doctor implemented and prescribed the new medication recommended on the report.  After his Doctor’s appointment, I conducted weekly follow-ups to see how Rafaz was doing as well as well as to offer guidance on what to expect, and how to mitigate the starting effects/ side-effects of the new medication.

Within three weeks of changing the medication, Rafaz informed me that he is feeling somewhat better and has requested that he returns to work.

“I Rafaz Mohamed confirm the above statements made by the pharmacist, Sandra Hanna. I am currently still feeling some side effects though.

Before using your service, I was beginning to feel very discouraged as all my previous medications that I’ve tried were not ideal. After agreeing with OSI to proceed with the DNA test, I felt somewhat hopeful again as there would be research done to actually see what medication was ideal for me instead of the trial and error method with medication and varying dosages.

I received my DNA kit within days. Instructions were very easy to understand and follow. After sending my DNA kit, I was in contact with Sandra within a week to follow up on her findings. Her report was well detailed and she took the time over the phone to go through every paragraph with me and summarize it in layman’s terms so I could understand and follow along. She answered all my questions and created a comforting environment for me to open up and speak to her. She followed up every week with me to see how I was doing and to provide some feedback to let me know if what I was feeling was normal or out of the ordinary.

After the first 3 weeks of Fetzima, I started to feel an improvement. I was sweating less at night, nausea was becoming less frequent, I had a better appetite, I felt less tired and was starting to be able to think more clearly. Urination and sexual issues were slowly subsiding as well. That being said, my doctor tried to increase my medication from 40 mg to 80 mg which was dropped to 60 mg but the side effects previously stated began to worsen again. I am currently back on 40 mg and am hopeful that the side effects will subside. 

I am now on a gradual return to work and am able to complete some work duties. I can feel an improvement in my mood. I feel more confident, happy, calm and most important I feel more at peace with myself.

I would definitely recommend this service to others. It can save them a lot of time jumping from one dosage to another or an entirely new medication completely. Not to mention they would not have to go through side effects as their body adjusts. It can help others get back to their lives quicker.

Thank you for everything you have done for me and helping me get back to reality. I’m hopeful that I will eventually be back to my normal self in no time.”

Best Regards,

Rafaz Mohamed

P.S: Mr. Mohamed recently provided PPI with a review of his experience, as well as giving Personalized Prescribing permission to use this document with insurance companies and disability managers.