How Pharmacogenomics Is Revolutionizing Depression Treatment
When it comes to treating depression, one of the biggest challenges has always been finding the right medication for each individual. Too often, people are left cycling through prescriptions, dealing with side effects, and feeling frustrated by the lack of progress. In a recent conversation with Dr. Talia Cohen-Salal, the CEO and co-founder of NeuroCare, we dug into why this trial-and-error approach fails so many—and how pharmacogenomics is finally offering a more personalized path forward.
Pharmacogenetic Testing: Matching Medication to the Individual
Pharmacogenomics, as Alan discusses in the latest podcast episode, refers to the integration of genetic testing into the process of medication selection. It combines a window into a patient’s unique biology with practical info on how their body will metabolize specific drugs.
Dr. Cohen-Salal’s company, NeuroCare, is flipping the standard protocol “on its head,” Alan notes, by emphasizing a process that matches the right drug to the right patient’s biology. As Alan explains, the prevailing medical approach has been to try one drug at a time: “Instead of a patient trying to get better at the drug that isn’t suited to their biology, we create that pairing and help patients get better faster.”
So how does this pharmacogenetic testing work in practice? NeuroCare’s process begins with a simple blood draw. According to Dr. Cohen-Salal, they transform those blood samples into patient neurons: “We go from blood to stem cell to neurons. We then have a window into the brain, a model of the brain of that individual patient. We can test all the different antidepressants on that sample, on that brain in a dish instead of in the patient’s brain.”
“We take that period of trial and error out of the patient and into the lab where it belongs.” – Dr. Talia Cohen-Salal
This approach means that, before a patient starts a single pill, NeuroCare can provide doctors with a report showing which medications have the strongest impact on an individual’s unique neural biology. No more “one-size-fits-all”—every patient gets a drug protocol tailored to their biology right from the start.
Comprehensive Testing: It’s Not Just About the Brain
Alan highlights another key aspect of NeuroCare’s method—comprehensive pharmacogenetic and metabolic testing. The process does not stop at identifying which drug best targets a patient’s neurons. As Alan notes, “We also include pharmacogenomics. So we also give that report together with the neuronal readout, which allows you to combine not just which drug is best, but also help understand how your lipid metabolism enzymes are going to process those drugs as well.”
Why is this important? Many side effects and treatment failures in antidepressants come not from the drug itself, but from how a patient’s body breaks it down. Genetic variations can influence how quickly or slowly your body processes medications, affecting their effectiveness and risk of side effects. By considering both brain response and genetic drug metabolism, providers can home in on the right medication—and the right dose—much faster.
Personalizing for Depression, PTSD, and More
Alan points out the major challenges in standard mental health medication, especially noting that, “I can’t even begin to number the prescriptions that I handed out to people…they come back with a quarter half full bottle or maybe even more. And—‘No, this can’t take this. It’s not working for me. It’s making me feel worse.’” Traditionally, every trial of a new medication is another gamble—with several weeks or even months invested each time.
With pharmacogenetic testing, that burden is dramatically reduced. The podcast discussion reveals that, while NeuroCare’s validation studies have focused on depression, much of the same antidepressants are used in PTSD (post-traumatic stress disorder) treatment. Dr. Cohen-Salal mentions ongoing collaborations to bring these personalized approaches to PTSD trials, and some doctors are already using the technology off-label in that space.
“We think that every individual is unique…there are so many, many, many subcategories that it’s impossible to get that level of clarity or detail at the moment in science. And so that’s why we treat every individual as a unique individual and see which drug would be right for them.” – Dr. Talia Cohen-Salal
Alan also discusses how these advancements are crucial, especially given the high rates of depression and related diagnoses. As Alan shares in the episode, “Around 25 percent of the population at some point in their life will have a depressive episode and 8 percent in a given year. But it’s twice as prevalent in women as it is in men.” He stresses the importance of vigilance in caring for loved ones, noting the different risks that depression poses to men and women—especially regarding suicidality in men.
Mental Health Genes and Lifestyle: Beyond Medication
Pharmacogenomics isn’t limited to drug response. Alan describes how comprehensive genetic testing for mental health also uncovers variants that inform non-prescription strategies. A prime example is the APOE gene, which is widely associated with neurological health and risk:
“Specifically, we’re looking for like the APOE and its variation. So if we have an APOE4, then what we do is we look back at, okay, what dietary options can we implement in this person that would assist in maybe quieting that down a little bit?” – Alan Ogden
This “broad view of the mental health genes” doesn’t stop at a diagnosis; it creates a roadmap for lifestyle interventions that can support brain health in parallel with medication, or even beforehand in some cases. Alan’s protocol, for instance, already incorporates some level of pharmacogenetics and will expand further in the coming months.
Seeing the Brain as a Whole System
Treatment of depression is as much about understanding the system as it is about the gene variants or the drug’s mechanism. Alan brings up the role of glial cells and glutathione in brain health, drawing on his own interest as a brain injury survivor: “One of their main functions is the production of glutathione. And that’s something that I personally studied, having been a brain injury survivor, making sure that the detoxification mechanisms in my brain are optimized, at least to the level that I a noticeable level in me.”
Dr. Cohen-Salal notes that the patient-derived neurons NeuroCare creates also include glial cells, giving a more accurate model of a real brain. That means any impact on different neuron types, or on these crucial immune-type support cells, is also captured—enriching the quality of medication matching possible.
Innovation and the Future: Psilocybin, Ketamine, and More
The conversation also touched on the rapid proliferation of new treatments in mental health—particularly psychedelics and cannabinoids. Alan notes the growing field, especially with government-supported research into psilocybin and, in Canada, regulatory changes around cannabinoids. Dr. Cohen-Salal explains that their “Bright Care” test currently focuses on FDA-approved depression treatments but that they work with pharmaceutical partners to vet new compounds—including ketamine and Spravato, with psychedelic collaborations underway for when those treatments receive formal approvals.
“Through that, we’ve actually been able to partner with different companies working in the psychedelics base, working with ketamine and some of those new compounds that are coming onto the market and already launched on the market with Spravato.” – Dr. Talia Cohen-Salal
Challenges and Regulatory Hurdles
Alan asks the practical questions too: What about access for patients outside the U.S.? For now, Dr. Cohen-Salal says patients would need to travel to the United States for such testing due to regulatory constraints. She emphasizes, “It’s important that it’s regulatory approved in the site where the blood was drawn,” and shipping across borders adds even more complexity. As interest grows worldwide, pressure may rise to harmonize or expand access to these advanced diagnostics.
The Takeaway: Personalized Mental Health Is Here
As Alan’s discussion with Dr. Cohen-Salal illustrates, the integration of pharmacogenomics, brain modeling, and comprehensive genetic testing is fundamentally changing how we approach depression and other mental health conditions. This isn’t about science fiction or therapies far off in the future—it’s here, now. Personalized medication strategies, tailored not just to a diagnosis but to your very DNA and biology, are within reach.
If you or a loved one have struggled with the long, painful process of finding the right depression treatment, know that options are expanding—and getting more precise all the time. To learn more about the full episode and the latest developments in mental health genetics, be sure to catch the podcast and watch this space for ongoing updates.
What’s been your experience with depression treatment? Are you curious how your genetics might influence your response to medication? Share your thoughts below or reach out to see if pharmacogenomics could help you achieve better outcomes faster—and with fewer side effects.