Is there a role for genetic testing in psychiatry?

Is there a role for genetic testing in psychiatry?

I often assess patients who have had a disappointing response to various medications, or in some cases, the medications that they have tried have been ineffective for them.

They may have also experienced deal breaking side effects from medication, such as sexual dysfunction, weight gain, over sedation, and severe nausea. These side effects often outweigh the benefits of remaining on these medications. Whilst I always follow evidence-based treatment protocols, there is still an element of trial-and-error with all medications because of an individual's genetic variations.

When faced with such scenarios, I usually recommend pharmacogenetic testing, which can provide recommendations for pharmacological treatment options based on one's genetic makeup. This really does help to diminish the trial-and-error process.

Genetics is the study of genes and how they work. Your DNA contains all of the 'information' that makes you who you are, from how you look, to your risk for future health-related issues. Genes are sections of your DNA, and whilst we all have approximately 20,000 genes, what makes each of us unique are the variations within these genes.

Pharmacogenetics (also referred to as drug-gene testing) is the study of how individual genetic variations can result in different responses to medications, and the differences in drug-metabolising genes. Some psychiatric medications may not work as effectively in some people with certain genetic variations, and different people will experience different adverse drug reactions.

How can you benefit from pharmacogenetic testing?

  • It can identify your specific gene variations
  • It will enable you to understand why you do not respond well to some psychiatric medications, or why they may be ineffective for you
  • It will identify your genetic profile and the clinical significance of your interactions with the medications commonly prescribed in psychiatry.

How I use a patient's pharmacogenetic test report/results

The report provides me with an analysis of the 24 genes tested. These genes have been shown in numerous clinical studies to have implications for response to the treatments used for the following mental health conditions:

  • Anxiety
  • Depression
  • Bipolar disorder
  • Obsessive Compulsive Disorder (OCD)
  • Post-Traumatic Stress Disorder (PTSD)
  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Autism
  • Schizophrenia
  • Chronic Pain
  • Substance abuse

These genes involve various neurotransmitter pathways including, to name a few, Serotonin, Dopamine, Norepinephrine and Glutamate.

They can be viewed from either a pharmacodynamic or pharmacokinetic perspective.

Pharmacodynamic genes relate to the effect of the drug on the body, including interactions with receptors and transporters. Pharmacokinetic genes relate to the effect of the body on the drug, including drug metabolism and absorption.

Based on your gene results, I am able to advise on the following:

  • Whether your genotype may be associated with altered drug metabolism or absorption, higher side effect risk, or higher risk of inefficiency
  • Whether your genotype has any known gene drug interactions
  • Whether your genotype may be associated with an improved response to a particular medication or class of medications.

The report also details the most effective psychiatric medication options for you, whether you are suffering with Depression, Treatment-Resistant Depression, ADHD, Bipolar, Anxiety related disorders, or pain.

Most medications are metabolised by liver enzymes. In the same way that you have a specific blood-type, you also have a specific genetic profile which can affect your rate of metabolism. This will likely also influence the dose of a given medication that is prescribed for you.

The report provides information about your metabolism status, as well as information regarding your specific gene drug interactions, which are unique to your genetic profile.

As an integrative psychiatrist, I consider mental health to be affected by the following three main areas that are encapsulated in the biopsychosocial model:

  • Biological, e.g., genetics, brain chemistry and brain damage
  • Social, e.g., life traumas and stresses, early life experiences and family relationships
  • Psychological, e.g., how we interpret events as signifying something negative about ourselves.

With pharmacogenetic testing, one is able to fine-tune the biological aspect.
Please do make contact if this is something that you would like to explore further.