Can genetic testing help me to choose psychiatric medications?
Change your life and mind through genetic testing for psychiatric medications
Pharmacogenetics can provide life-changing information regarding which drugs may work best based on your genetic makeup. It can assess how your body metabolizes and reacts to different medications, which can help you find the best ones based on your genetic makeup.
Let’s break it down:
There are two types of pharmacogenetic tests available, each with its own design and method of analysis.
- Pharmacokinetics – genetic variations directly affecting drug metabolism, clearance, and levels in the blood.
- Pharmacodynamics – variations in brain receptors and other proteins that are targeted or triggered by the drug.
Each test provider selects a different set of genetic markers to analyze. Some psychiatric tests, including Genesight, Gencept, CNSDose, analyze genes related to metabolism, clearance, as well as pharmacodynamic genes. The caveat: because these providers use different markers and make their own rules interpreting results, there is a lack of consistency between tests. This can lead doctors to wonder which one was correct.
It’s important to note that:
The effect of genetic variations on drug metabolism and clearance is undeniable. Regulatory bodies, including Health Canada, the FDA, and the European Medicinal Agency, all include warnings on how genetic variations affect drug exposure and clinical response, increase the risk for adverse events, and sometimes provide genotype-specific dosing limitations.
Did you know?
Recently, a group of experts called the Clinical Pharmacogenetic Consortium (CPIC) reviewed the evidence for both pharmacokinetic and pharmacodynamic genes to provide more consistent recommendations on the interpretation and use of genetic tests.
Here’s what came out of it:
A new guideline recommends testing for CYP2C19, CYP2D6 and CYP2B6 (pharmacokinetic) genes, which strongly affect the metabolism and clearance of commonly used psychiatric medications. The Pillcheck test includes the recommended genes and reports according to CPIC guidelines. At the same time, the CPIC review highlighted there is still inconsistent evidence for pharmacodynamic markers, for example, the serotonin transporter gene and others implicated in the risk of weight gain and response. Therefore, psychiatric genetic tests relying on pharmacodynamic markers are not recommended.
But how is that helpful?
This can be important information to discuss with your healthcare provider if you’re considering genetic testing for psychiatric medication. Many doctors are concerned with the risk of drug-induced side effects and often use the “Start Low, Go Slow” approach with drug dosage. This can leave patients in a mental health crisis at risk while their treatment builds up to therapeutic doses.
The plus side:
Pharmacogenetic testing for CYP2C19, CYP2D6 and CYP2B6 genes shows which drugs your body eliminates too fast or too slow. With this, your doctor can choose a medication that is less likely to cause harmful side effects and is more likely to be effective. By doing this, doctors can minimize the trial-and-error process of finding the right medication, reduce the risk of adverse reactions and get to the optimal dosage faster.
The more you know:
According to studies, patients who have undergone DNA-guided drug selection and dosing have a 40% higher chance of achieving remission. A study using Pillcheck also showed that genetics-guided therapy accelerated recovery for patients with mild to moderate anxiety and depression. Other studies have shown major differences in therapy effectiveness within 8-12 weeks of receiving genetic testing results. This could be helpful for people struggling with mental health issues.
Now, not all doctors are familiar with pharmacogenetics. However, there are expert pharmacists who can assist with interpreting DNA test results in the context of your prior medication history and experience. The Pillcheck service includes such a medication review, which is especially helpful for those struggling with mental health and seeking a more personalized treatment option.
Sound helpful for you or a family member? Check if your benefits provider offers coverage.
Many insurance providers in the US and Canada (such as Canada Life and Medavie Blue Cross) include this testing in their plans or will reimburse you through Healthcare Spending Accounts (HCSA). Consider Pillcheck as a preferred option and discuss it with your healthcare provider. Pillcheck offers high-sensitivity DNA testing to provide results for people of various ancestries. Plus, it’s super easy to share results with your doctor.
Use Pillcheck to avoid side effects and feel better sooner
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Bousman CA et al., Review and Consensus on Pharmacogenomic Testing in Psychiatry. Pharmacopsychiatry. 2021 Jan;54(1):5-17.
Bousman CA et al., Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A Genotypes and Serotonin Reuptake Inhibitor Antidepressants. Clin Pharmacol Ther. 2023 Jul;114(1):51-68.
Brown LC et al., Pharmacogenomic Testing and Depressive Symptom Remission: A Systematic Review and Meta-Analysis of Prospective, Controlled Clinical Trials. Clin Pharmacol Ther. 2022 Dec;112(6):1303-1317.
Bousman CA, Dunlop BW. Genotype, phenotype, and medication recommendation agreement among commercial pharmacogenetic-based decision support tools. Pharmacogenomics J. 2018 Sep;18(5):613-622.
Papastergiou J et al., Pharmacogenomics guided versus standard antidepressant treatment in a community pharmacy setting: A randomized controlled trial. Clin Transl Sci. 2021 Jul;14(4):1359-1368.
Bousman CA et al., Encountering Pharmacogenetic Test Results in the Psychiatric Clinic. Can J Psychiatry. 2022 Feb;67(2):95-100.