Mental illness starts at birth, says Mark Faiz, CEO of Personalized Prescribing Inc. In the Benefits and Pensions Monitor Meetings & Events ‘Lessons Learned from the Management of Disability Due to Mental Illness’ session, he said, “We are all born with genetic variations that could make us predisposed to mental dysregulation. But that alone does not cause the mental illness, that is only a predisposition. What causes the mental illness is a trigger. Usually, the trigger is a chronic stress of some kind, although some trauma, injury, and some diseases can be the trigger that cause the dysregulation.”
For mental illness to occur, the predisposition and the trigger are necessary. For disability to occur, something else is needed. One cause is psychotropic medications. These are very challenging versus other medications and fail almost 50 per cent of the time. They also come with adverse drug reactions which can be so bad that the person stops using them because of the insidious side effects before they have had a chance to be effective.
The reason for the challenge is “simple, it’s the brain,” he said. “We’re talking about the most complex organ in the body by a longshot.” And it is why mental illness medication eventually could cause disability.
Unfortunately, antidepressants, do not work like other medications. They may take six to eight weeks to become effective. They are started at low doses which are increased gently over two or three weeks. “And in the meantime, you’re really not feeling a difference, but you might be suffering from the side effects,” said Faiz. And this makes people stop taking them too soon.
Tests Or Biopsies
Complicating matters in managing mental illness disability diagnosis is challenging compared to other conditions. Other ailments can be diagnosed through tests or biopsies. “Unfortunately, you can’t take a piece of the brain and put it under a microscope,” he said.
The other issue with mental illness disability management is there is no predictable or systematic process for rehabilitation. “We’re not sure of when to start the rehabilitation process and when do we know that rehabilitation has reached its conclusion.” he said.
This makes pharmacogenetic testing an important part of the process.
Faiz says they have learned that individuals have variations in genetic scores and those with very high genetic variation scores are likely to be resistant to some medications.
Testing for these variations informs pharmacists on how a patient will respond to the three aspects needed for a medication to be effective ‒ drug clearance or how quickly the drug is cleared from the blood and the brain; how the brain barrier, which is trying to protect the brain and perceives drugs as invaders, lets the drugs in; and how the brain receptors are targeted and impacted.
“We learned that almost 30 per cent of our disability patients were treatment resistant,” he said. “It doesn’t mean that there’s no help for these people, but our pharmacists have to use more than one medication to fix the genetic problems within the brain.”
So people can end up with a mental illness disability just because they’re having problems finding the right medication. This is not always the case, he said. “When a person who is mentally ill finds the right medication, you never hear about it. They’re managing their illness and they are fine.”
The final lesson he has learned has nothing to do with medications or science, it’s motivation. “We find there are people who are very motivated and they want to come back to work,” said Faiz. Being actively at work indicates that their mental illness is fairly recent and they’re still struggling with it, but they are motivated and trying to deal with it.
With employees on disability, there’s a wide array of patient attitudes. Almost a third of them are quite motivated and they really want to get better. A third are difficult to work with, they aren’t motivated, but eventually come around after pharmacists reach out to them once or twice. Finally, there’s another third of disability patients referred by their disability case manager who doesn’t even agree to take the pharmacogenetic test.
“The one thing that we found out is generally the faster you get to somebody after they get a mental illness that has become serious, the easier it is to keep them at work or return them to work,” he said. “If you let them descend into long-term disability, we have a problem because they simply lack motivation.”