The Role of Pharmacogenetic Testing in Psychiatry

Pharmacogenetic testing is a way to check how your genes will affect your body's response to a specific medication. Your DNA can affect whether you have a positive or negative reaction to a drug, or whether it works for you at all.

Pharmacogenetic testing (or pharmacogenomics) can help psychiatrists select the right antipsychotic drugs for each patient based on their unique genetic makeup. This can lead to better and faster recovery from mental health issues.

You see, as the saying goes, "Different strokes for different folks." Simply put, what works for one person may have little or no effect on another. And that's the situation we face in psychiatry.

People respond differently to antidepressants and antipsychotic drugs. While an antidepressant may be effective in some patients, others may not respond at all to the drug. And this is a major challenge to both mental healthcare providers and their patients alike.

Let's take depression as a case study.

Did you know that rate of response to initial antidepressant treatment was only about 49%? And the saddest part is, people who do not respond well to depression treatment are more likely to have suicidal thoughts. That isn't good news.

Hundreds of drugs are available for treating psychiatric/neurologic patients. But the use of the drugs has been riddled with side effects and lack of effectiveness, making the whole process less satisfying for patients and their psychiatrists.

Why? Because, historically, psychiatrists have always relied on empirical data when selecting medications for patients. The choice of medication was made based on using clinical indicators from the patient's symptoms and past similar cases to draw rational conclusions on the best course of action.

It's best practice, but still, psychiatrists usually have to go slow to minimize any possible side effects. This necessitates a trial phase, where the patient still has to bear the symptoms while the healthcare provider determines how the drug works for the unique individual. The trial may even last up to a month. While some patients have favorable responses during this trial, others experience side effects or zero responses that will warrant stopping the medication.

It's not very pleasant; patients do not want to wait a month before experiencing relief from agonizing PTSD symptoms or panic attacks. But this approach has always been the best way to go about personalizing mental health treatment for patients.

Enter pharmacogenomics.

About two decades ago, genotype testing became more affordable due to advancing technology and knowledge. And then, in 2004, the FDA approved AmpliChip. This was a turning point in psychiatry, as psychiatrists could now test and compare genetic variations of their patients to predict whether or not they will respond to a drug and what the response will be like.

Thanks to pharmacogenetic testing, psychiatrists can now create personalized treatments for their patients by choosing the best medication for them. This is because they would be able to predict what drug will work best based on the patient's unique genetic makeup. Little or no trial phase, immediate relief from whatever awful mental health symptoms the patient had been experiencing.

How Does Pharmacogenetic Testing Work in Psychiatry?

There is a strong relationship between genetic variants and enzymic activity, and most antidepressants/antipsychotics are metabolized by enzymes. Pharmacogenetic testing in psychiatry works by looking at variations in certain genes that play a role in how antidepressants/antipsychotics are metabolized in the individual, thereby predicting how their body will respond to the drug.

This all emphasizes that there's no one-size-fits-all approach to mental illness. Personalized treatment is key. Thanks to pharmacogenomics, personalized pharmacotherapy for mental illness is possible.

Pharmacogenomics is still a growing area in psychiatry, and there's room for improvement. The potential is great, and that's reassuring for patients and providers alike.

Author

Satu H. Woodland, PMHCNS-BC, APRN Satu Woodland is owner and clinician of Hope Mental Health, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.  Ms. Woodland with her background in nursing, prefers a holistic and integrative approach to mental health care that addresses the mind and body together. While Ms. Woodland provides medication management services in all her patients, she believes in long-lasting solutions that include a number of psychotherapies, namely cognitive behavioral therapy, exposure and response prevention therapy, attention to lifestyle, evidenced based alternative psychiatric care and spirituality. If you’d like to gain control over your mental health issues, call Hope Mental Health at 208-918-0958, or use the online scheduling tool to set up an initial consultation.