What is Genetic Testing For Mental Illness Looking Like?
I had posted an article on this website several months ago about the search for bio-markers that would give us an indicator if someone has a proclivity for developing a mental illness later in life. These studies focus on depression and anxiety and often bipolar disorder. Some of these tests have made great strides.
This year in 2014 I have recently started using genetic testing as a tool to help guide me and the patient in starting a particular medication treatment. The way these tests are used is to help direct the most appropriate medication per the particular patient’s genetic make-up. Again these tests are (relatively) inexpensive and assist us in determining which medications will work best with the patient based on his or her genetic make-up. These are not cures but might open the doors to new discoveries that may someday cure certain mental illnesses. The good news is that many insurance companies are covering these genetic tests for mental illness.
It is performed either by a mouth swab or sputum obtained in a test tube, soon to be mouth swab, right in my office. There are two labs that I am aware of that perform
these tests, Millenium and Assurex Health or GeneSight. These tests have only recently been made available in the past year.
The results generally are obtained in 36 to 72 hours. The results appear like a traffic light, showing in green the antidepressants and anti-psychotics best suited for the patient’s genetic make-up (i.e. usually the ones most tolerated), in yellow, those to use with caution, and in red those to use with even more caution and more close monitoring, if at all. Other tests results obtained are analgesics, ADHD medications and the MTHFR genetic mutation, used to determine if someone would be helped with the medication, Deplin.
My Clinical Findings Are Increasingly Vindicating The Value of Genetic Testing – Helping us Get the Right Medication Management ASAP
I have found in the last one and 1/2 months of using these tests, that they have been a good guide, in that, I have a patient who was in the yellow for the antidepressant, Lexapro. The footnote told me that this patient may need higher doses of this medication, which she had already responded to with a partial response. I had added Deplin previously, without benefit. I was unaware of her need for a higher than recommended 20 mg dose of this medication, until I did the testing with her. I was able to go up to 30 mg with this test. The patient’s depression went right away with this adjustment. Also, she was in the green with the Deplin, meaning she didn’t really need it. So, I removed the Deplin; and the patient is now doing much better.
I had another patient who after being on Olanzapine and Cymbalta for about the last four years; and was stable with her Bipolar Disorder all of the sudden developed slurred speech and trouble feeding and clothing herself necessitating her husband’s help to do this. She had previously also been working full-time; but she no longer was able to do so. She was seeing a number of specialists for a number of medical conditions. We were all tapering her off the medications to determine what might be causing this. I was able to get her genetically tested; and the results showed that she was in the red for the Olanzapine and Cymbalta. Therefore, I tapered her off these; and she was in a depressed episode, so I started her on a medication for this that was in the green for her, Latuda. She was also in the red for Deplin, so I added this. She is now, not feeling the depression nearly as badly as she was. Her speech is no longer slurred; and she is back to work.
Among the Sciences, Bio-Marker in Psychiatry Are Becoming Subjects of Great Research in Order To Bring More Empirical Evidences to This Field of Medicine
Psychiatry, as you can see, now is no longer in the dark ages with just the ability to take an educated guess as to what someone might respond to. Now, we have a guide that usually can direct us to the medication that the patient will not only tolerate; but also as you can see respond to in a much greater frequency. As I tell the patients, this is not always a cause and effect though, since the first patient I described was in the green for Pristiq, which I had given her before the testing. She had a decompensation on this medication actually having suicidal ideations. So, when the test results came back, we were both kind of scratching our heads on that one; but it has proved to be an invaluable resource, especially in patients that aren’t responding after multiple medication attempts. Please check back as I will be updating this article as more information comes in as I use these genetic tests, confer with my colleagues with respect to their successes and continually update this article.