What about genetic testing for psych meds?

Image representing double helix pattern of genetic DNA
Image source: Wikipedia

Patients ask: “What about genetic testing to determine which psychiatric medications I need?”

Mark R. Ogle, M.D., Board-Certified Clinical Psychiatrist in Indianapolis, IN, answers.

Is there a family connection? 

Like most medical illnesses, many psychiatric illnesses have a genetic component to them.  Depression, anxiety, bipolar, schizophrenia—all tend to run in families. One of my favorite history-taking questions is to ask what medicine a family member with a similar illness has responded to—and often I will recommend that same medicine for you. If you have a “first-degree relative”—that is, a parent, sibling, or child—who has done well on Lexapro, there’s a good chance it’ll work for you.

On the other hand, I’ve also had patients who tell me, “My mom has done great on Lexapro for many years, but it didn’t do anything for me when I tried it.”

Genesight and other forms of genetic testing

A drug-finding tool that’s been getting increasing prominence in the media in recent years is genetic testing. Genesight is the most popular and common one, although there are competitors—for convenience I’ll refer to “Genesight” testing from here on out.

The way Genesight works is that a cotton swab is used on the inside of your cheek. The cells scraped off are sent to a lab, and within a week or two I get a printout of various classes of drugs—antidepressants and bipolar meds are the most common, although you can get pain meds, ADD meds, etc. included as well—and how they would agree with your genetic makeup.

The drugs are divided into three (3) categories: green, yellow, and red, based on the Genesight company’s data about how they’re metabolized by the liver, and how well they’ll work with your individual genetic traits.

“It sounds very high-tech and scientific. How does it work in reality?”

Clinical Reality: No “silver bullet”—and other unforeseen side effects

The reality is that I’ve been pretty disappointed in how helpful the Genesight tests are in clinical practice. While it’s been useful in some patients with tweaking their medicines, it’s certainly not been a silver bullet for the majority of the several dozen patients I’ve seen it done on.

Why the disconnect between the promise and the reality? Just because your liver can break down a medicine well doesn’t necessarily imply that you’ll be able to tolerate the side effects from that same medicine. Conversely, the proprietary data the company uses to project effectiveness of medicines can’t be duplicated and replicated by other scientific researchers—because the company keeps its testing data private. Many [clinicians] speculate that Genesight’s data are partial, at best.

What are the downsides of the Genesight testing? The test itself is painless. The main downside is the cost; it is covered by most insurance, but as with everything medical it’s expensive—in pure dollars—so, if you have a high deductible or marginal insurance, you could get hit with a surprisingly large bill. The other downside in my mind is the false hope it gives some people that this test will be THE ANSWER and that everything will be smooth sailing once they get on the “right” medicines, as predicted by the test.

A prescription for perspective and an open mind

I like to keep an open mind, and all information is useful information. If you’ve had the Genesight done at another medical practice, certainly bring it in for me to look at. There’s even some chance that I will recommend the Genesight test, for patients who have a difficult-to-treat illness and/or have had struggled with medication side effects in general. This is a tool, and can be a useful tool. We just have to keep it all in perspective.