Genomica
Psychiatry’s first prescription is a guess. Genomica makes it a decision. Coming soon
Only about one in four people with depression reach remission on their first antidepressant.1 Psychiatry still prescribes largely by trial and error, and for most patients that first choice is worse than a coin toss.
Genomica is genetic clinical decision support for psychiatrists: mapping a patient’s genome to mechanism to drug, so the first prescription is an informed one.
Today’s psychiatric genetic tests mostly report how a patient metabolizes drugs. Genomica’s aim is different: to model the biological networks behind a patient’s symptoms, and show a clinician why a treatment is likely to fit, with the reasoning visible.
Why mechanism, not averages
Medicine acts downstream, on population averages. A large trial washes out an effect that only shows up in people with a particular variant, like slow COMT: an average can hide substantial benefit for some, little for many and harm for a few.2 And drug studies on single genetic variants are rare; formal prescribing guidance covers only a limited set of gene–drug pairs.3 Some of those effects may never appear in a study, because of how the studies are designed.
Doctors often act on those averages, at the end of the pipeline. Genomica starts at the beginning, with the person and their genome. It gives a physician a plausible path from known research and known mechanisms to a decision, and keeps that path auditable, so it can be brought into medication management and checked.
Where it is
In development. This is research, not a medical product, and nothing here is medical advice. If you’re a psychiatrist, researcher or investor working on precision psychiatry, I’d like to hear from you.
Sources
Footnotes
-
First-treatment remission in the STAR*D trial was 28% to 37% in the original report, and 25.5% in Pigott et al.’s 2023 reanalysis (BMJ Open, 2023). The original investigators dispute the reanalysis. ↩
-
Kravitz, Duan and Braslow, Evidence-Based Medicine, Heterogeneity of Treatment Effects, and the Trouble with Averages, The Milbank Quarterly, 2004. ↩
-
The Clinical Pharmacogenetics Implementation Consortium’s list of gene–drug pairs with published guidelines. ↩