Quick Answer: While genetic testing for psychiatric medications can potentially identify certain genetic variations that influence the body’s reaction to certain medicines, there is no definitive determination with regard to which psychiatric medication may be most effective. Most useful when taken in the context of symptoms, history, prior medication response, and clinician’s judgment.
The screening of psychiatric medications using DNA can seem like an easy method to get to that “right” antidepressant or psychiatric medication. The truth is a complicated one. The tests look at some genetic changes that could affect how fast different drugs are broken down by your body or how you react to the drugs.
What’s important here is that a genetic test might be helpful, but it is not a guaranteed predictor of mental health treatment outcomes. Your symptoms, diagnosis, any other medicines you are taking, physical health, lifestyle, experiences of treatment, and your preferences continue to count.
When the side effects of a number of drugs have proved difficult or efficacy has not been substantial, genetic testing could provide another fact to weigh for a prescriber.
Key Takeaways
- Many genetic variants can be tested to be accurately identified.
- Can be used to clarify variation in drug metabolism and drug–gene interactions.
- It is not for diagnosis of depression, anxiety, schizophrenia, bipolar disorder or other mental illnesses.
- It doesn’t mean it can predict which medication will best function.
- One such commercial pharmacogenomic test is called GeneSight testing.
- Interpretation of results should be done by a competent health care worker.
- Overall, genetic testing should be used as an adjunct to rather than a sole answer.
According to the National Institute of Mental Health, there is a genetic link to some mental disorders, but most psychiatric disorders are polygenic, meaning that a combination of genes, environmental, and life factors plays a role.
When Might Genetic Testing Be Considered?
Genetic testing will not detect psychiatric symptoms. Rather, they might use pharmacogenomic tests when they feel a patient has information in their psychiatric history that would benefit from information from the tests.
For instance, determination might be talked about if an individual:
- Has made multiple attempts at antidepressants with inconclusive results.
- Has severe side effects from frequently used medication.
- Has trouble with regular dosage.
- Takes several medications that could interact.
- Has chronically unusual sensitivity to medications.
- Needs more detail before talking with a prescriber about starting another medication.
This is not intended to be a substitute for a physical evaluation. Rather, the test might provide some information about a portion of the picture of medication response.
Some genetic differences may cause a person using an antidepressant medication to break it down faster or slower than desired. In some cases, those facts would affect the choice of the medicine or the dosage given.
But symptoms are key. There is no easy ability to diagnose anxiety disorders, bipolar disorders, schizophrenia, and other psychiatric disorders through simply scanning a person’s genes. NIMH claims current genetic tests are not accurate in predicting an individual’s susceptibility to mental illness.
Why Do People Respond Differently to Psychiatric Medications?
Much more than DNA determines how a person responds to a medication.
Drug-metabolizing enzymes sensitive to changes in genes. These genes include, but are not limited to, CYP2D6 and CYP2C19, which affect the way several medications are metabolized.
However, there are other considerations that are important. Medications can affect the person unpredictably due to age, liver or kidney function, other drugs, smoking, alcohol or substance use, sleep, diet, pregnancy, dosage, attentiveness to taking the medication or the psychiatric illness itself.
That’s why genetic testing for psychiatric drugs shouldn’t be thought of as a crystal ball.
While genetics can offer a valuable lead, genetics is not the complete story. The FDA collects information about pharmacogenomic markers included in drug labels, including some psychiatric drugs, which may have a genetic implication in drug dosing, safety, metabolism, or clinical effect.
How is Genetic Testing for Psychiatric Medications Performed?
Pharmacogenomic testing can be done using either a saliva or a cheek swab sample, depending on the type of test ordered; some tests may require a blood sample. The lab analyzes certain genetic variants and generates a report that physicians can use when thinking about treating a patient with a drug.
This test is not used for the diagnosis of a psychiatric disorder.
Rather, it can determine whether an individual has the genetic traits linked to variability in the metabolism of the drug or to some drug-gene interactions.
The report, for instance, may show that an individual is going to metabolize a drug more or less rapidly than normal. That information could lead to changing the dosage of that medication, switching medications or more frequent monitoring, depending on the medication and strength of the evidence.
The accuracy of the DNA measurement and usefulness of the clinical recommendation are therefore two separate issues. A test may precisely detect a gene variation but not be able to precisely predict that a specific drug will help relieve a patient’s symptoms.
According to the American Academy of Family Physicians, GeneSight can definitely identify the genes it evaluates, but that’s where the difficulty begins in understanding what the implications are for the suggested medications.
Need Help With Psychiatric Medication Management?
If you are struggling to find a medication that works well for you, consider discussing your options with a qualified psychiatric provider. Orlando Premier Psychiatry can provide professional psychiatric evaluation and medication-management services, including guidance on whether genetic testing may be appropriate for your situation.
How Can Genetic Testing Help With Psychiatric Medications?
In psychiatric care, genetic testing aims to deliver extra information that might help in determining the use of medication.
Can it be used to select a drug?
Potentially, yes.
An ancestral remedy report might outline prescriptions that have known gene-drug interactions, or it might recommend that some medications be considered. It can be especially helpful for those who’ve tried various medication types and had to deal with unwanted side effects or failures.
But it does not order every psychiatric drug for an individual from “best” to “worst.”
Does it aid in dosing?
Sometimes.
Some of the genes may influence the rate at which a drug is metabolized. Information may be useful to a clinician to consider reconsideration of standard dosing if an individual is predicted to be a poor, intermediate, normal or ultrarapid metabolizer of a relevant pathway.
How about GeneSight testing?
A case in point is the well-known GeneSight test, which gives a comprehensive profile on some psychiatric medications. In a review published in American Family Physician, the test looks at many genes and drugs and categorizes outcomes based on gene-drug interaction.
However, it should not be viewed as a promise that treatment will be effective for any person based on a GeneSight report. Some discrepancies have been reported with regard to the short-term response and remission, although with regard to longer-term results, findings have been more varied.
That is why genetic testing for psychotropic drugs is best when used in conjunction with and not as a substitute for the individualized treatment of the patient with psychiatric disorders.
If you’re having trouble finding a medication that is working for you, we are available to discuss treatment options for your behavior and addiction. Contact us to talk to a team member and find out the next step.
How Accurate Is the Evidence?
The evidence suggests that there may be a role for pharmacogenomics testing, but it’s not necessarily treated as a good predictor.
The AAFP review cited the large randomized gene-guided treatment trial for MDD in which there was better response and remission at 8 weeks. However, symptom improvement and adverse effects did not differ significantly after the study groups were “unblinded” to which groups had received blood flow stimulator therapy or a sham procedure.
That distinction matters.
In the light of current knowledge, there are indications that pharmacogenomic data can be used clinically for certain patient-specific situations, particularly when the metabolism of a drug is relevant, or when a specific gene-drug interaction is relevant. But it is not a pledge that gene tests can be used to predict pharmaceutical efficacy in the psychiatric realm.
Also in its guidance, FDA says that pharmacogenetic information may be among the many factors that are “potentially relevant to a health care provider’s care of a patient with respect to therapeutic planning, dose, or susceptibility to therapeutic benefit and/or toxicity.
Side Effects and Limitations
There are relatively few risks associated with the physical act of DNA collection, either by saliva, a cheek swab or by bleeding. Misapplication of results, cost, expectations, and interpretation are larger issues.
Possible limitations include the following:
- The test might give results that will not affect care.
- Not all drugs have clinically important genetic markers.
- Results can be interpreted as a promise for the effectiveness of the medicines.
- Insurance coverage varies.
- Response to medication may be influenced by factors that are not addressed by the results.
- Claims that are greater than the evidence can be made in direct-to-consumer testing.
The FDA cautions consumers to be wary of claims made by pharmacogenetic tests that predict response to specific medication which have not yet been substantiated.
How Much Does Genetic Testing for Psychiatric Medications Cost?
Finally, insurance and assistance, as well as clinical factors and the cost of the genetic testing for psychiatric medicines vary. A Medicare rate to pay GeneSight is $1,569 in 2020, and the manufacturer made a statement that many patients paid significantly lower out-of-pocket costs, according to an AAFP review. Patients should note that costs and coverage may vary; please confirm costs before testing.
Is Genetic Testing Worth It?
It might be worthwhile to discuss genetic testing if psychiatric medicines have been tried repeatedly and it still hasn’t worked well or there have been side effects. Less useful to consider as an automatic quick-fix to an ideal medicine. The results should be interpreted in the context of your clinical situation by your clinician.
How Can You Use Genetic Testing Safely?
When that starting to think about a genetic test for psychotropic medication, make it a part of a general discussion about therapy.
Ask about the information the test can give you.
Before testing, inquire about the type of medication the test checks and if the results might have a real impact on care.
Medication History.
Talk about medications used in the past, medication doses, side effects, side benefits, allergies, or supplements taken, and other medications.
Do not ever change medicines without permission and instruction.
The genetic report isn’t a prescription. Do not, on any account, STOP, GO UP, or GO DOWN any Psychiatric drug without consulting with the prescription-giving clinician.
Let’s begin by discovering why this test is true or false:
Ask if there are any clinical guidelines or FDA labeling for the recommendations and strong peer-reviewed research.
Take precautions to guard your genetic information
Before providing DNA (genetic information) to a laboratory, know how they treat, use and share DNA with others.
Keep expectations realistic
The point is to provide better information for care, not a surefire answer.
Then how accurate are genetic tests for psychiatric drugs? The correct answer is that these tests can be useful in identifying certain gene variants, but it is a lot less useful in selecting the right psychiatric medication for a particular individual.
Genetic testing information for psychiatric medications may prove helpful if a response to the medication has been difficult to manage, especially when clinically relevant aspects can be identified between genes and drugs. However, genes are not the only aspect of treatment.
At Florida Atlantic Coast Treatment Solutions, a personalized treatment plan is based on the entire individual, rather than a single test.
If you are having concerns related to medication and it is impacting your recovery or mental health, this doesn’t mean that you have to deal with it on your own. Call Florida Atlantic Coast Treatment Solutions at (844) 643-2287 for help and treatment suggestions.
Get Professional Psychiatric Support
Having difficulty finding the right medication can be frustrating. Orlando Premier Psychiatry can help you explore psychiatric evaluation, medication management, and whether GeneSight testing may be appropriate for your situation. Speak with a qualified provider before making medication changes.
Frequently Asked Questions
Does genetic testing for psych meds work?
Yes, it can provide useful information about how genetic differences affect the metabolism or handling of certain medications. However, it cannot guarantee which psychiatric medication will work best. Results should be combined with symptoms, history, diagnosis, and clinical judgment.
Which mental disorder is the most genetic?
There is no single mental disorder that can accurately be called “the most genetic.” Schizophrenia, bipolar disorder, autism spectrum disorder, and several other conditions have substantial genetic contributions, but many genes and environmental factors influence risk.
Is there a blood test to determine the best antidepressant?
There is no blood test that can definitively determine the best antidepressant for everyone. Pharmacogenomic testing can examine genetic factors related to medication metabolism and response, but treatment decisions still require clinical evaluation and ongoing monitoring.
Can genetic testing be done for mental illness?
Genetic testing can identify certain variants associated with disease risk or medication response, but it cannot currently diagnose most mental illnesses or accurately predict who will develop them. NIMH recommends interpreting genetic information alongside personal and family health history.
Is there a downside to genetic testing?
Potential downsides include cost, uncertain clinical usefulness, confusing results, privacy concerns, and unrealistic expectations. A test may identify a genetic difference without providing a clear treatment change. Results should therefore be interpreted by a qualified healthcare professional.
Can you see schizophrenia in genetic testing?
No. There is currently no genetic test that can definitively diagnose schizophrenia in an individual. Schizophrenia has a strong genetic component, but many genes contribute to risk, alongside environmental and developmental factors.
What is the hardest mental illness to live with?
There is no objective ranking of the hardest mental illness to live with. Conditions affect people differently depending on symptoms, severity, support, treatment access, and other circumstances. Severe depression, schizophrenia, bipolar disorder, and substance use disorders can all be profoundly disruptive.
Is bipolar genetic from mother or father?
Bipolar disorder is not inherited from only the mother or only the father. Many genes contribute to risk, and genetic factors can come from either parent. Environmental and life experiences also influence whether someone develops the condition.
What are the 10 common genetic disorders?
Examples of genetic disorders include cystic fibrosis, sickle cell disease, Huntington disease, hemophilia, Tay-Sachs disease, Marfan syndrome, fragile X syndrome, Down syndrome, phenylketonuria, and thalassemia. These are different from complex psychiatric conditions, which usually involve many genes and environmental influences.
Medical Disclaimer: This article is for educational purposes only and does not replace diagnosis, treatment, or medication advice from a qualified healthcare professional. Do not start, stop, or change psychiatric medication based solely on a genetic test result.
References and Authoritative Sources
- National Institute of Mental Health: Looking at My Genes and Mental Health
- U.S. Food and Drug Administration: Pharmacogenomic Biomarkers in Drug Labeling
- U.S. Food and Drug Administration: Pharmacogenetic Associations
- American Academy of Family Physicians: GeneSight Psychotropic Genetic Testing for Psychiatric Medication Selection
- National Institute of Mental Health: Genetic Basis of Mental Disorders Program
