Linda Riches, shown in this handout image, tried at least 12 different antidepressants before one worked for her.HO/The Canadian Press
Loss. That’s the word that comes to mind when Linda Riches thinks of the debilitating depression that robbed her of the ability to fully care for her son, advance in her career and pursue her goal of a PhD in education.
Riches, 67, said she was prescribed at least a dozen antidepressants, starting in her 30s, but they failed to lift her mood while she missed a lot of days in her job as a high school teacher. When she would return to work, she felt isolated and alone among co-workers she believed would have responded differently if she’d had a physical illness.
“If you’ve been off because of a mental health issue, people just don’t want to talk about it. So they ignore it. Nobody wants to come and say, ‘Is there anything I can do to help you?’ ” she said from her home near Prince George, B.C.
Years went by as she started to lose hope before one medication turned out to be the right fit.
Now, Riches says she hopes others can avoid a trial-and-error experience by having a genetic test to help predict which drugs would likely work best for them and cause fewer side-effects.
Known as pharmacogenomic testing, such personalized treatment is available for a fee. A lab examines DNA obtained from a sample such as from blood, saliva or a cheek swab to identify the genetic variants that affect how the patient would metabolize and respond to specific medications.
Riches is one of three patients who took part in a University of British Columbia study into the cost savings offered if pharmacogenomic testing were to be publicly funded.
A study published Tuesday in the Canadian Medical Association Journal suggests that providing the test as a standard part of care could save $956-million over 20 years for the health-care system in British Columbia alone. That excludes all the personal and economic savings from people returning to work, being able to afford child care and having a better quality of life.
Stirling Bryan, a senior author on the study, said more than 35 antidepressants are available in Canada but nearly half of patients do not respond to the first medication they are prescribed and about a quarter of those report intolerable side-effects.
Genes are responsible for about 42 per cent of the variation in how people respond to antidepressants, said Bryan, a professor at UBC’s school of population and public health and a senior scientist at Vancouver Coastal Health Research Institute.
Researchers accessed about 194,000 patients’ health data from 2015 to 2020. It included medications they were typically prescribed for major depression as well as clinical trial data linking genetic information to appropriate antidepressants. From that, they developed a simulation model for how people would fare over 20 years if they did not have pharmacogenomic testing compared with predictable outcomes with that testing.
Bryan said about 37 per cent of patients who don’t respond to various medications are deemed to have treatment-resistant depression, sometimes after they give up trying out of frustration, at which point they may need more doctors’ visits, including psychotherapy. They could also end up in hospital for electroconvulsive therapy (ECT) or other treatment, adding to health-care costs.
“One in 10 Canadians will experience major depression in their lifetime,” said Stirling, believing that widespread availability of pharmacogenomic testing could save billions of dollars throughout the country.
Beyond the financial savings, the study showed that an anticipated 1,869 lives would be saved over 20 years, Bryan said.
Few patients get a genetic test to determine which antidepressants could be best suited to them, but more people are choosing that option, usually by spitting into a tube they mail to a lab.
However, doctors may not know how to interpret someone’s genetic profile to help guide their prescribing decisions, said Bryan, urging more education on that through a program that would fund the testing.
Research on pharmacogenomic testing is also under way elsewhere in Canada.
Dr. Paul Arnold, a child and adolescent psychiatrist and director of the University of Calgary’s Mathison Centre for Mental Health Research and Education, is involved in a study for patients between ages six and 24 who are either starting on medication or about to switch to a different drug.
DNA samples have so far been collected from about 1,000 patients in Alberta, British Columbia, Saskatchewan and Alberta, but the goal is torecruitanother 2,000 children and young adults, Arnold said.
The study initially included participants up to age 18 but expanded because most mental illnesses start before age 25.
The samples are being tested by a publicly funded lab but the hope is that costs could eventually be covered by the Alberta government depending on findingsafter researchers analyze prescribing patterns and changes in use of health-care services, Arnold said.
“The exciting thing about pharmacogenomic research is that you can see the immediate impact,” he said. “The goal is to catch (patients) early, before they go through that journey of having been on multiple medications without success.”
Dr. Jitender Sareen, a psychiatrist who is medical director of the mental health program for the Winnipeg Regional Health Authority, said plans are under way to launch a study that would determine the impact of pharmacogenomic testing for hospitalized adults, including seniors taking medications for multiple conditions.
“Our aim is to recruit all adults but we wanted to start on our inpatient units because there is mixed evidence about whether this kind of pharmacogenomic testing can actually reduce the length of hospitalization,” he said.
Pharmacogenomic testing currently costs between $200 and $400, but providing it to everyone who needs antidepressants would benefits the health-care system, care providers in the community as well as patients, Sareen said.
“People get tired of trying different medications and this could at least help guide treatment.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
