Anxiety disorders affect one in six Australian adults each year and often occur alongside depression and other disabling conditions. With an increasing number of patients delaying or avoiding GP visits due to cost pressures, improving treatment for those living with anxiety has never been more urgent. Recognising this need, researchers are launching the Living with Anxiety study—a large-scale investigation into the genetic and environmental factors that influence both the development of anxiety disorders and the response to treatments, particularly antidepressant medications.
The Challenge of Treating Anxiety
While psychological therapies remain the first line of treatment for anxiety, antidepressants are commonly prescribed either as a second line or in combination with therapy. However, these medications can come with a range of adverse reactions—from initial side effects like headache, nausea, and sleep disturbances to longer-term issues such as weight gain and sexual dysfunction. It is estimated that up to 20% of individuals on antidepressants experience distressing side effects, a major factor leading to medication discontinuation.
Harnessing the Power of Pharmacogenomics
Pharmacogenomics offers the promise of precision medicine by helping clinicians tailor medication choices based on an individual’s genetic makeup. Tests in this field can predict which antidepressants are likely to be most effective and which may cause adverse reactions. The Clinical Pharmacogenetics Implementation Consortium (CPIC) has developed guidelines for commonly prescribed antidepressants—including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Despite these advances, a recent position statement by the Royal College of Pathologists of Australia (RCPA) highlights that such pharmacogenomic guidance is rarely implemented in Australian healthcare.
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A 2019 analysis of 52,000 individuals from the Estonian Biobank found that up to 65% of patients prescribed an antidepressant had genetic markers predicting non-response, suggesting that many might have benefited from an alternative medication or dosage. This evidence underscores the potential benefits of integrating pharmacogenomics into clinical practice, yet large-scale studies reflecting the diversity of the Australian population remain urgently needed.
Introducing the Living with Anxiety Study
Funded by the National Health and Medical Research Council (NHMRC), the Living with Anxiety study aims to fill this gap. Unlike previous genetic studies that focused primarily on identifying risk factors for anxiety, this study is designed to deliver practical insights into which genetic and environmental factors may predict an individual’s response—both in terms of benefits and adverse side effects—to common interventions.
Study Design and Methodology
Participants in the study are Australian adults who have experienced an anxiety disorder, with particular emphasis on those who also live with co-occurring conditions such as depression. Volunteers complete comprehensive online questionnaires that detail:
- Personal experiences with various treatments, including benefits and side effects
- Types of medications used
- Current life circumstances, health status, and lifestyle factors
Following the questionnaires, participants are invited to provide a saliva sample via a mail-out kit. This sample enables researchers to perform DNA extraction and pharmacogenomic analyses, thereby linking genetic profiles with treatment outcomes.
Potential Impact on Clinical Practice
The Living with Anxiety study is not solely about identifying genetic risk factors; its primary goal is to inform more personalised and effective treatment strategies. By understanding how genetic variants affect treatment response, clinicians may be able to optimise medication selection and dosing, ultimately reducing the trial-and-error process that currently frustrates many patients. This approach promises not only to improve individual patient outcomes but also to offer key insights that could guide government decisions on the Medicare-based funding of pharmacogenomic tests.
Moreover, by aggregating data from a large and diverse cohort, the study will contribute to global efforts—such as those catalogued by PharmGKB—to refine our understanding of the genetic underpinnings of medication efficacy and side effects. Such evidence is crucial for making cost-effective and clinically effective decisions in the long term.
A Call for Participation
The study team encourages anyone aged 18 and over who has been diagnosed with and treated for an anxiety disorder to volunteer. By participating, individuals can contribute to research that may one day streamline the process of finding optimal treatments for anxiety and co-occurring conditions. Those interested can learn more and sign up at livingwithanxiety.org.au or email lwa@qimrberghofer.edu.au.
Looking Ahead
The ultimate aim of the Living with Anxiety study is to bridge the gap between emerging genetic insights and everyday clinical practice. As the field of pharmacogenomics continues to evolve, this research could pave the way for a more efficient, sustainable, and personalised approach to mental health care in Australia. With better-tailored treatments, the hope is that fewer patients will endure the frustrations of trial-and-error medication management, and more will achieve a better quality of life.
By advancing our understanding of the interplay between genetics and treatment outcomes, the study represents a significant step toward improving care for those living with anxiety—offering a glimpse of a future where precision medicine is not just a promise, but a reality.
