"Pharmacogenomics Saved My Life"

“My family won the genetic bipolar lottery,” says Mehri Coulter, 36, of Boise, Idaho. “My great-grandma, grandma, mom, sister, and nephew had or have bipolar.”

But it wasn’t something her family talked about growing up and she didn’t know bipolar existed in her family. So when Mehri was diagnosed with bipolar disorder out of college, she was shocked. She had a brand-new degree in business, a new fiancé—and this new diagnosis. Mehri was extremely depressed and withdrawing from others, prompting her doctors to put her on an antidepressant commonly known as an SSRI (selective serotonin reuptake inhibitor). For more than ten years, she says she felt “just mediocre. I thought that was normal.”

Talking about mental health and mental health history within families is a positive step, and it is only recently that mental illness has entered the national and global conversation. Mental Illness Awareness Week (MIAW) is October 3-9, 2021, and the World Health Organization (WHO) marks October 10 as World Mental Health Day. The purpose of MIAW is to raise awareness about mental illness; destigmatize conditions such as bipolar, anxiety, and borderline personality disorder; and show support for the millions of people who suffer, as well as the loved ones and colleagues who are affected. MIAW was first designated by US Congress in 1990. Bipolar had only been identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM) ten years earlier, and it would be another 13 years before the human genome was fully sequenced. The healthcare system still has a long way to go toward understanding and managing various disorders, but organizations like National Alliance on Mental Illness (NAMI), as well as researchers in the field of genomics, have made great strides in supporting patients and studying how precision medicine might help them and their families.

Symptoms and side effects
Over the years, Mehri suffered in a myriad of ways. She was angry, depressed, suicidal, and had a lot of anxiety. She also experienced hypomania and hypersexuality. Mehri was very sensitive to medications, which were changed often.

“I had some of the most horrific side effects from the medications. One was the exploding head syndrome,” she says. “It literally sounded like my head was exploding. It was the scariest thing I’ve ever experienced. Also horrific was not being able to hold my baby because some of the medications made my muscles not function correctly. It was devastating.”

Mehri and her husband had three small children, and he traveled for work. It was a lot to balance. She not only endured multiple symptoms and side effects, but she also lost time going to countless doctor visits and incurred innumerable expenses. “When you get a $300 bottle of pills and you try it for a week and it doesn’t work, it’s like pouring money down the drain,” she recalls. But mostly she remembers the frustration of not having answers.

Moving through a storm
“My husband, Logan, would say, ‘We’re just going to keep trying. Like the buffalo.’ They’re the only kind of animal that will not seek shelter but actually move as a herd through a storm. My husband and I have decided we’re always going to head strongly into the storm together. Cause we’ll get to where we’re going faster.”

About three years ago, Mehri flew to the Mayo Clinic in Rochester, Minnesota to do genetic testing. The test required a single blood draw and can tell a patient how he or she might respond to certain medications, according to that person’s genetic variants. The study of pharmacogenomics, also known as PGx, involves understanding the human genome and pharmaceutical drug metabolism, and can advance personalized medicine.

While Mehri had to travel to a specialized clinic for PGx testing, today there are several companies that will send a test in the mail. The test, which can be prescribed by a healthcare provider, is a simple cheek swab that a patient can return through the mail. PGx companies then connect the person with a health care professional trained in using PGx data for prescriptions.

After Mehri received her test results, the doctors at Mayo recommended an SNRI (serotonin norepinephrine reuptake inhibitor). “It was a matter of a few weeks really before my life completely changed.

“I remember calling my husband crying and of course he was on full alert. He was like, ‘Oh no, another one’s not working.’ But I said, ‘Honey, I feel normal for the first time in forever.’ And I really was genuinely terrified that it was going to be taken away from me. I was so used to trying a new med and something going wrong. I was waiting for the other shoe to drop. But it never did. For me to be this stable for the last three years in comparison to the rest of my life is a freaking miracle.

“Pharmacogenomics absolutely saved my life and not only my life, but my kids’ lives, too. For my husband, it saved our marriage in many ways. It saved our family.

“But having bipolar has made me who I am. I’ve developed a lot of grit from it. And I’ve been reading that grit is what determines happiness. So there’s my silver lining.”

Read Mehri’s So Bipolar blog or follow her on Instagram @so_bipolar.

Learn more about pharmacogenomics and PGx testing here.