Let’s start with what genetic testing is and what it isn’t in psychiatry. Genetic testing has become widely popular as a way to discover your family origins and as a risk assessment to alert you to potential inheritable diseases you may be predisposed to.
In psychiatry, genetic,or pharmacogenomic, testing is a tool to determine how your body metabolizes certain drugs–the more appropriate and less sexy name for it is psychopharmacological genetic testing. Without further ado we’ll discuss if this is a good option for you.
In psychiatry we don’t always have the best track record–we have a low response rate to medications and some of the most bizarre side effects out there. Genetic testing will help determine if your body, more specifically the cytochromes in your liver, break drug treatments down appropriately. You can fall into a range of being an ultrarapid metabolizer which means you break things down way too quickly and the medication can fall short of a therapeutic response.
Conversely, you can be a slow metabolizer, meaning you break medications down too slowly and medications can build up causing you to experience a host of undesirable side effects. There are normal metabolizers out there too–and this is where we want to play to your strength and match you with medications you break down appropriately. There are a lot of nuances and to make it more complicated drugs are broken down by multiple pathways, but that’s for another time.
Another benefit of psychopharmacological testing is that you can apply it to other fields of medicine. When you get a report you can take it with you to other healthcare providers. Information is power. I have had patients find out that they are ultrarapid metabolizers of anesthetic agents or certain pain medications which can have serious implications with surgeries or procedures.
One feature I particularly like is that genetic testing checks for MTHFR gene mutation, which is quite common in the general population. This means your body needs a little help with utilization of dietary and/or supplemental folate. Folate has a direct impact on mental health particularly with major depressive disorder. Once we discover this gene mutation, we can easily overcome this with specialized supplementation that your body can put to good use.
The genetic testing service we use can be completed in the office or at home and is a simple cheek swab that gets mailed back to the laboratory for processing. An individualized report is generated which we will go over together. There is also an included feature to have a PharmD complete a consultation with a more in depth analysis of your report if desired.
Typically test results come back within two weeks and you will receive a report that you can save to your computer or print out and bring with you to other healthcare providers. I can always update the current medications that you are taking into your report and new medications are always being added to reflect new innovations in treatment.
The results of your genetic testing will not change over time. New medications are developed, but most will follow primary metabolic pathways to break down medication. Drug/drug interactions can alter the way medications are metabolized, but we can include medications or supplements you are currently taking and add medications that you may be considering to minimize potential interactions.
The genetic testing database also includes common substances like nicotine, caffeine, alcohol, marijuana and other commonly used substances that impact your metabolism of medications. We are all adults here, unless you are a savvy 9 year old with a predilection for psychiatry blogs, in which case I tip my hat to you, but this section should not apply.
One of the main questions I get asked by my patients, usually sheepishly toward the end of the appointment, is “Can I smoke marijuana with this or can I drink alcohol with this medication?” My answer is something like “in a perfect world, I recommend not to, but I can tell you from an interaction standpoint ….” It is okay to ask. Keep in mind aside from interactions, you will have a unique way of metabolizing these substances so for some people more is really more.
Genetic testing will not tell you what kind of adverse effects that you may experience. Sometimes we can anticipate based on the drug profile what kind of common side effects may occur with high drug serum levels of a particular medication. Genetic testing is quite accurate in terms of measuring what it sets out of measure and the fact that your metabolic pathways do not alter greatly over time. The main question is the utility of the testing for you.
Some reasons patients opt for genetic testing is they have had serious side effects to a medication or they are not getting the desired response from a treatment they are currently taking. Sometimes patients take a more guided approach before they even consider starting treatment.
Medication side effects can not only cause physical or psychological discomfort, but can make it difficult for patients to work, go to school, attend social events, care for children, safely drive or otherwise function in daily activities. Many patients are deemed “non adherent” to treatment, but with treatment like that who wants to be adherent?
In seeking symptom improvement, it’s crucial to consider all available tools and resources. While genetic testing offers a personalized approach to medication management, it’s important to note that not all tests and methodologies are directly regulated by the Food and Drug Administration in the United States.
However, this doesn’t detract from their potential value in guiding treatment strategies. In some cases, understanding your unique metabolic profile can lead to adjustments in medication types or even a higher dose to achieve the desired therapeutic effect without exceeding safety parameters. This nuanced approach allows for a more targeted and effective pathway to managing your health concerns.
As a medical provider working in psychiatry for several years, there are times when I am stumped or I see a new patient who comes to me having suffered from past medication side effects or a lack of therapeutic response. I do not want to cause harm and my goal is to heal. The solution is most often not to add more medications, but to select the most appropriate treatment plan for the individual.
Psychopharmacological testing is a tool and with the guidance of a healthcare provider can optimize treatment. Cost can be a deterrent to some, but if you have a history of unwanted side effects or fear them or prefer an individualized approach to treatment and can afford $399 then it’s an excellent option.
Lindsay is a board-certified advanced nurse practitioner specializing in an integrative approach to treating mental health concerns. Lindsay draws upon a combination of pharmaceuticals, supplements/botanicals, nutrition, and mind-body approaches that are evidence-based.
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