Genetic Influence on Medication Response

Pharmacogenetic testing aims to genetically guide prescriptions to improve patient response and decrease side effects. We are living at an exciting time in science and pharmacogenetic testing is another tool that can guide a more precise treatment plan. Factors such as the environment and lifestyle choices (nutrition, exercise, meditation, etc) are always taken into consideration when arriving at the best treatment plan for each individual.

On my recent podcast I had the honor of interviewing Daniel Mueller M.D., Ph.D who is an associate professor at the Department of Psychiatry at the University of Toronto and is the Head of the Pharmacogenetics Research Clinic at Center for Addiction and Mental Health and is a clinical psychiatrist at the Mood and Anxiety Program at CAMH.

Dr. Mueller and I discussed the importance of genetic factors, specifically the genes encoding for CYP450 liver enzymes. CYP450 enzymes are a group of mixed function monooxygenases that are responsible for metabolizing almost 50% of all marketed drugs (*Gibbs et al.,2005).

Polymorphisms (genetic variation) in the CYP450 genes yield enzymes with different pharmacodynamics (the study of how the drug affects the organism) and pharmokinetic (the study of how an organism affects a drug) properties. An individual may be classified as an extensive metabolizer (EM), intermediate metabolizer (IM), poor metabolizer (PM), ultra-rapid metabolizer (UM) (*Gibbs et al., 2005). Dr. Mueller discussed the benefits of using pharmacogenetic testing for clinicians to identify outliers who are non-EM status and who carry higher risks for non-response, adverse events and side effects.

*Gibbs, C., Fisher, P., Hernandez, J., Mrazek, D., O’Kane, D., Snyder, K., 2005. Cytochrome P450 Enzyme Genotyping: Optimizing Patient Care Through Pharmacogenetics, In: Services, M.R. (Ed.), pp. 1-10.

Dr. Mueller and I discussed that at present the use of pharmacogenetic testing is not mainstream (yet?) due to cost and the need for continued research. If you have a history of poor response to medication or intolerable side effects ask your doctor if a consideration for a pharmacogenetic test would be beneficial to maximize your treatment and wellness plan. It is important to remember that pharmacogenetic testing is a tool that is utilized in combination with your doctor’s expertise and that there are multiple factors that play a role in your health and wellbeing.

Thank you Dr. Mueller for your contributions to science and psychiatry.

For more tips check out: Mental Health and How to Thrive

“Liars, Lying and More Lying” with Dr. Deborah Budding and Dr. Denise

Dr. Deborah Budding and Dr. Denise on “Liars, Lying and More Lying”

Dr. Deborah Budding is a board certified neuropsychologist who works with children, adolescents, and adults in the Los Angeles area. She has a background in literature and magazine publishing prior to earning her Ph.D. in psychology. She is co-author of “Subcortical Structures and Cognition: Implications for Neuropsychological Assessment,” which was published in 2008, as well as peer-reviewed articles related to subcortical contributions to cognitive and emotional function, including a Consensus paper on cerebellar contributions to both movement and cognition published in 2013. She has strong interests in neuroscience, art, and video games, not necessarily in that order. Dr. Budding is a supervising faculty member at Harbor-UCLA’s neuropsychology training program and is increasingly involved in research involving transcranial direct current stimulation (tDCS). She has particular interest in the cerebellum’s contributions to non-motor function, in brain-behavior relationships in neurodevelopmental disorders, and in finding ways to amplify the voices of women and people of color in science education.

Psychiatry & Meditation for Daily Stress

Being healthy and well requires a level of physical and emotional awareness for ALL of us.

This is why I prescribe mindfulness as part of every mental health thrive plan for children, teens and adults.

As a board certified adult and child psychiatrist that has seen thousands of patients I view a practice of mindfulness as “exercise for the brain” that sets the foundation for optimal mental health. The long term benefits of a meditation and/or a mindfulness practice are endless and can include an improved immune system,reduced anxiety, improved mood, increased focus, improved cognition, improved compassion and more. Many people report a greater sense of connectivity to something larger than themselves and a mind that is open to more possibilities.

Did you know that 70-80% of life long mental health issues start before age 24? That is why I believe every tip, tool or strategy for mental health and thriving is important for my patients and for ALL of us. As a mother, wife, and psychiatrist my mindfulness mantra “Be loving. Be kind,” allows me to stay connected to my higher self and to recycle stress into love throughout my day.

I believe the integration of meditation as a universal wellness tool into our homes, offices and schools will have long lasting societal health benefits. Last spring I highlighted the Harvard neuroscience research on meditation in my post “Create The Best Version Of Yourself With Meditation and Mindfulness.” In another post, “The Mindfulness Prescription”, there were many tips and tools included about the practice of mindfulness. I am passionate about wellness and prevention and envision current and future generations of children having the tool of meditation as a standard “mind medicine” for wellbeing.

Last year I met Michel Pascal. Michel is a meditation teacher and author of “Meditation for Daily Stress: 10 Practices for Immediate Wellbeing”, to be released this April.

It is my goal to integrate a more formal understanding of meditation into my practice of psychiatry and to share my experience of implementing behavioral plans that include cognitive behavioral strategies and mindfulness techniques. Michel and I co-produced “Emergency Well-Being,” a video series discussing the importance of bridging psychiatry and meditation, which was released on February 17, 2017.

For more tips check out: Mental Health and How to Thrive

Pharmacogenetics with Dr. Daniel Mueller

Dr. Daniel Mueller, M.D., Ph.D (@mueller_dj) is an associate professor at the Department of Psychiatry at the University of Toronto and is the Head of the Pharmacogenetics Reseach clinic at Center for Addiction and Mental Health and is a clinical psychiatrist at the Mood and Anxiety Program at CAMH.

He has published more than 160 articles with the focus of his research being on an investigation of the genetic factors that predict response to antidepressant and antipsychotic medications.

He has been awarded the Klerman Prize for exceptional Research in Clinical Brain and Behavior Science by the US based Brain and Behavior Research Foundation in 2013 and the Innovation In Psychopharmacology Award by the Canadian College Of Neuropsychopharmacology in 2016. He is a true pioneer in setting expert guidelines for patients and doctors in the area of pharmacogenetics, the branch of pharmacology concerned with the effect of genetic factors on reactions to drugs.

Instrumental Music from the song JUST SIMPLIFY
Sung by Michel Pascal
Composed by Paul Pesco
Lyrics Michel Pascal and His Holiness Dalai-Lama, from the book “Instants Sacres”
© 2016

Dr. Natalie Trent, Harvard Neuroscientist, on Mind/Body Research

Natalie L. Trent, Ph.D. is a Postdoctoral Research Fellow, sponsored by Kripalu Center for Yoga & Health, at Harvard Medical School, and Brigham and Women’s Hospital, where she investigates the mind-body practices of yoga and mindfulness on health and wellbeing. She also conducts research on Reiki, universal love, psychedelics, and other mind-body practices. Natalie is a Reiki Master Teacher and incorporates aspects of shamanic traditions into her practice. She is a key participant in the Campaign for Open Sciences and the movement toward a Post-Materialist Science. Natalie is a contributing author to The Beacon of Mind and co-editor of Expanding Science: Visions of a Post-Materialist Paradigm, both published by Param Media. You can visit her website at

Instrumental Music from the song JUST SIMPLIFY
Sung by Michel Pascal
Composed by Paul Pesco
Lyrics Michel Pascal and His Holiness Dalai-Lama, from the book “Instants Sacres”
© 2016

Onward and Upward! Happy 2017!

The amount of gratitude as I start to write this post is immeasurable. Why? I met and collaborated with some amazing souls in 2016 that have ignited an “altruism momentum” that leaves me speechless. This includes ALL of you that are reading this and have been a part of this journey. Mindset is everything and your support of raising awareness of the importance of mental health leaves me inspired and humbled.

With ALL of your support and inspiration this year I launched the site, a podcast and released an ebook to give you tips, tools and facts about mental health and how to thrive. Thank you for your support and follows on Twitter @DrDeniseMD and on FaceBook too!

Are you ready for 2017? Many of my patients, followers, colleagues and loved ones have been anxious to move past this year and even want to “slam the 2016 door shut” after this hostile election year coupled with the many visionaries and artists that have passed away. As individuals and as a collective WE all experience life stages of being in crisis, creating a foundation of stability and reaching a place of thriving.

How can WE continue to heal and thrive in 2017? By learning to shift the energy of fear, sadness and rage into the vibration of LOVE.

How do WE do this? We can ALL pause and look in the mirror and ask OURSELVES, “What can I do to make this year the best for my own health and wellbeing as well as for my family, for my community and for the world at large?” WE can take action in large or small ways with clear intentions as every thought, word and action that we have as individuals affects our health and wellbeing.

As I was typing this post one of my dear friends texted me to wish me Happy New Year and said that after seeing “Rogue One” her new phrase for 2017 is, “I am the Force. And the Force is with me.”

This was divine timing as I was just about to write this thrive tip: Find your own phrase, song, meditation or mantra to keep you in the vibration of hope, inspiration and gratitude throughout the year.

Happy New Year to ALL of you and your loved ones!

With love~

Dr. Denise