Psych Genetic Testing—The Good, The Bad, and The Indifferent

There are so many patients who suffer with treatment-resistant anxiety or depression.  Many clinicians, not just psychiatrists, but frequently family doctors and internal medicine doctors are searching for answers in a patient’s genetics when every medicine they try either doesn’t work or has horrible side effects for a particular person.  What does that look like for the patient?

 You go to your doctor, you try a medicine.  It doesn’t work.  You go back to your doctor, you try a different medicine, but it kills your sex drive or makes you gain 20 pounds or causes brain fog.  You try a different medicine, and yay!  It works!  But when you increase the dose it causes a rash or an elevation in your liver enzymes.

 So your doc recommends something along the lines of genesight testing.  The patient thinks: “Yay!  This will tell me the medication that is tailor-made for my genetics and it will work and I will feel awesome and I will have little to no side effects!”  Except…not so much.

 What many primary care docs are unaware of is the fact that genetic testing for psychiatric medication coordination CAN BE helpful, but it’s certainly not the be-all-end-all.  Why do I say this?  Well, we need to be educated about what current genetic testing can provide us info about and what it CANNOT tell us.  It’s a relatively easy test to perform, it just requires a cheek swab in office.  No blood required.

 Whenever you take a psychiatric medication, it is typically metabolized one of two places in the body.  Most commonly, it is processed in the liver, less commonly, the kidneys.  So right off the bat, we could say, if you suffer with certain liver or kidney diseases, we know that certain medications SHOULD NOT be prescribed to you. 

Especially in the liver, we are all born with a different subset of enzymes.  If you have a large amount of one particular type of enzyme, you may be a RAPID metabolizer of a drug that uses that particular type of enzyme, therefore, you may need a larger amount of that drug than the general population because your body processes it too quickly.

If you have a small amount of a particular type of liver enzyme (or don’t have it at all) you’d be considered a SLOW metabolizer of certain drugs.  Medications that use that enzyme to be metabolized in your body may need to be given at smaller or slower doses because your body may hang onto the drug.  Or, it may be a case where you shouldn’t even be taking that drug at all if you don’t have the enzymes to process it!  These medications would hang out in your body longer and cause problems and very likely side effects.

Certain psychiatric medications are targeted to specific brain receptors.  If you don’t possess these brain receptors, or have them in low quantities, it would make sense that those drugs that target the receptors you don’t have would likely NOT WORK for you.

What genetic testing does is three-fold: 

1.      It tells us what liver enzymes you have to process different types of drugs.

2.   It tells us what types of receptors in your brain that different drugs may target.

3.    It cross-references what you have and what you don’t have in relationship to what psychiatric medications are available on the market.

So when the patient and the clinician get a readout of the genetic testing, based on your own results, it will show certain psychiatric medications as a GREEN LIGHT, YELLOW LIGHT, or a RED LIGHT, just like a traffic stop.

Let me pause right here, because what most people believe is YAY!  I’ve found all the drugs that will work for me because they are all under the green light!  OR alternatively, I need to stop taking all of my meds because they are under the red light! 

THAT WOULD BE A MISTAKE. 

The only thing that a green light means, as in a traffic stop, is that you are SAFE to take that medication.  Based on your liver enzymes, and based on your brain receptors that are cross-referenced with that particular medication, you are SAFE to take it. 

1.      THAT DOESN’T MEAN YOU SHOULD.

2.   THAT DOESN’T MEAN IT WILL WORK.

All it means, is that, of all the medications listed, these are the least likely to cause you nasty side effects or problems down the line.

Just as a YELLOW or RED light doesn’t mean you SHOULDN’T take that particular medication.  There are lots of reasons meds show up in this category.

One reason would be that you are a slow metabolizer of a particular drug.  That just means that your clinician should start at a low dosage and move slowly to monitor for side effects more frequently than if you were taking a “green light” drug.

Another reason a med could show up in a yellow or red light category is because your are a rapid metabolizer of a particular drug.  That just means that your clinician should feel more comfortable escalating the dosage more quickly if you are not having a response, since your body gets rid of it more quickly than the general population.

When a drug shows up in a yellow or red category because it “doesn’t know how you metabolize it” I tend to avoid it like the plague because you’re kinda playing Russian roulette with how you’re going to respond.

So all in all, genetic testing can be a helpful tool when a person hasn’t responded to multiple different medication trials or has had nasty side effects to many drugs.  However, please note that the test itself could cost upwards of several hundred dollars and not all insurances cover the cost of it. 

You need to have the most information possible, and educate yourself the best you can so you can empower yourself to make an informed decision.

So, if you found this information helpful, please like, subscribe, and follow us!  Tell your friends.  We’re @AndersonClinicCincy on Facebook, Instagram, and TikTok. And you can find our Psych Waves podcast on Apple and Spotify.  If you happen to be in the Cincinnati area and are looking for assistance with treatment-resistant depression, anxiety, or PTSD, give us a call at (513) 321-1753.  Start feeling better faster.