It’s true that many people struggle with mental health conditions, and finding the right medication can take time. While commonly prescribed antidepressants like SSRIs are effective for mild to moderate anxiety and depression, they may not be suitable for everyone. Some people may not tolerate the side effects of antidepressants or may not find them effective. Similarly, while antipsychotics are effective for people with bipolar disorder, obsessive-compulsive disorder, and personality disorders, the stigma surrounding psychiatric medications and fear of side effects can lead many to avoid seeking proper treatment. It’s essential to work closely with a mental health professional and DNA-guided therapy selection to find the right medication and treatment plan that works best for you.

Which symptoms can psychiatric medications help to solve?

There are many types of psychiatric medications used to treat different mental health and neurological conditions. Based on multiple studies, it was discovered that some antipsychotic medications work better than others to alleviate specific symptoms and conditions. Although the following drugs are prescribed for a broader range of illnesses, for the following conditions, these drugs were found to be the most effective:

• Aripiprazole (Abilify) – Bipolar mania and Tourette’s syndrome (TS)
• Olanzapine (Zyprexa) – Bipolar depression and post-traumatic stress disorder (PTSD)
• Lurasidone (Latuda) – Major depressive disorder (MDD)
• Risperidone (Risperdal) – Obsessive-compulsive disorder (OCD).

If you already unsuccessfully tried multiple antidepressants, using these psychiatric medications, perhaps in combination with anticonvulsants, could help you to alleviate your mental health conditions.

How do I find which psychiatric medication will be safe and effective for me?

Your psychiatrist will consider treatment options that best match your diagnosis and symptoms. Many doctors are concerned with the risk of drug-induced side effects and, therefore, use the “starting low and going slow” prescribing approach. However, this approach leaves patients at risk for mental health crises until the optimal therapeutic drug dose is reached. Commonly prescribed psychiatric medications are metabolized by different liver enzymes. DNA testing for these liver enzymes provides insights into how your body processes and eliminates various medications, guiding therapy selection.

Genetic testing can help assess whether your body eliminates the candidate drug too slowly (leading to side effects) or too fast (reducing drug efficacy). This information helps your doctor choose from among the psychiatric medications and adjust the dosage to fit your metabolism. Following genetic testing, careful therapeutic monitoring of drug levels in the blood helps to minimize the risk of side effects.

Which pharmacogenetic tests are best for psychiatric medication?

There are several types of genetic tests available. While some genetic tests focus exclusively on psychiatric medications, many of them use their own proprietary rules for interpreting the results. They also include psychiatry-specific genes such as SLC6A4 (serotonin receptor), HTR2A, DRD (Dopamine receptor), COMT, or MTHFR, which have inconsistent evidence and sometimes provide conflicting recommendations. Such inconsistency of recommendations between various psychiatric genetic tests made doctors wonder which one is correct. After all, if you have done your blood work in a different lab, the values for lipid, sugar and other biomarkers should be identical. Shouldn’t there be a common standard for PGx tests?

To solve this issue, a group of experts formed the Clinical Pharmacogenetic Consortium (CPIC), which recommends standardized testing and interpretation based on the level of function of a person’s liver enzymes. Their new guideline recommends testing for CYP2C19, CYP2D6 and CYP2B6 genes, which substantially affect the metabolism and clearance of the vast majority of psychiatric medications.

At the same time, the CPIC review highlighted that there is still insufficient evidence for the psychiatry-specific genes implicated in the risk of weight gain and the effectiveness of psychiatric medications. Therefore, using psychiatric genetic tests that rely on these markers is not recommended.

Pillcheck follows CPIC guidelines and standardized reporting according to Health Canada and FDA labelling.

Benefits of Pillcheck’s medication review

In addition to your DNA, other factors such as your age, biological sex, other medications, diet, and smoking can have substantial effects on medication effectiveness and tolerability. The Pillcheck service includes a medication review by an expert clinical pharmacist who will evaluate your prior medication history in the context of your DNA and lifestyle.

For example, if you are a smoker, the pharmacist will alert your doctor about substantially reduced effects of asenapine, olanzapine, loxapine and other medications if you have a specific variation in the CYP1A2 gene.

For women on birth control pills or hormone replacement therapy, the dosage of some medications may need significant adjustment. Estrogen increases lamotrigine clearance, so levels typically decrease by 50% within one week of starting an oral contraceptive, thus requiring a dose increase. Alternatively, dosage reductions may be needed when hormonal contraception is stopped.

Flagging pertinent drug interactions with other medications you are currently taking will help your doctors make appropriate adjustments to ensure safe and effective therapy across multiple conditions.

According to several studies, patients who have undergone DNA-guided drug selection and dosing have over a 40% higher chance of achieving remission. One 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 improvement in therapy effectiveness within 8-12 weeks of receiving genetic testing results for psychiatric medications. This could be helpful for people struggling with mental health issues.

Have you checked with your benefits provider to see if they offer coverage for genetic testing related to psychiatric medications?

Many insurance providers in the US and Canada now include this type of testing in their benefits plans or reimburse the cost through Healthcare Spending Accounts (HCSA). You may want to consider Pillcheck as a preferred option and discuss this with your healthcare provider. Pillcheck offers high-sensitivity DNA testing to provide accurate results for people of various ancestries. Plus, it’s super easy to share your results with your doctor.

Summary

• Psychiatric medications can help to improve the management of many mental health conditions.
• DNA-guided prescribing can help your doctor find the right psychiatric medication and dose that will be safe and effective for you.
• Select a pharmacogenetic test that follows a guideline-based interpretation rather than a proprietary psychiatry-specific test. Standardized guideline-based tests will ensure consistent dosing recommendations and help optimize other medications you might be taking.
• Pharmacogenetics-based medication review will provide more contextual recommendations based on your symptoms and medication history.

Selected References

Feng X-Z et al., Effectiveness and safety of second-generation antipsychotics for psychiatric disorders apart from schizophrenia: A systematic review and meta-analysis Psychiatry Res. 2023 Dec 2:332:115637.

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.