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Gene Testing To Guide Antidepressant Treatment: Has Its Time Arrived
Depressive disorders are among the most common conditions that disrupt lives. Fortunately, medications, psychotherapies, and lifestyle changes are usually successful in treating depression and related disorders, even if symptoms are not entirely eliminated. Sometimes people dont gain sufficient relief from treatment, or must try several medications before finding one that works well. In an age of exciting advances, including brain imaging and genetic testing, many doctors and patients reasonably hope that new technologies will offer answers. And in fact, for antidepressant choice, several companies sell genetic testing as a means to guide treatment. But do these tests work?
Genes, gene testing, and depression
Genes determine some of our risk for depression and some of our response to treatment. However, no single gene or small number of genes determines much of either in the general population. And the few genes used in the current commercial test panels do not appear to be the key genes determining risk or response. Some of the genes tested are related to drug metabolism. These genes can affect drug levels in the blood, but generally dont predict clinical response. Other factors, including age, diet, hormonal state, gut bacteria, and any other concurrently taken drugs, are far more important in determining how a person metabolizes a drug and responds to treatment.
What do the studies tell us?
Why are gene tests so appealing?
If gene tests arent effective, what is?
Can Pharmacogenetics Help You Choose The Best Psychiatric Medication
Genetic testing for mental health medications is a relatively new field. The field of pharmacogenetics studies how the genome responds to drugs. Proponents say that understanding the genomes role in pharmaceutical treatments could enable doctors to increase success rates when prescribing antidepressants and antipsychotics.
Although use is quite limited today, clinical studies pave the way to potentially choosing more appropriate prescriptions for patients and decreasing the number of adverse reactions.
Psychiatric genetic testing has already demonstrated intriguing results, and the field continues to advance in a positive direction.
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What Is Genetic Testing Targeted To Mental Health And How Does It Help
We have all heard about the rise in at-home, direct-to-consumer genetic testing by companies such as 23andMe. But what you havent been hearing much about from your psychiatrist is genetic testing targeted to your specific mental or emotional health issue. This is called Pharmacogenomics, originally developed by the Mayo Clinic and Cincinnati Childrens Hospital in 2013 with Assurex Health. Identifying certain genetic markers, called pharmacogenetic markers, in a patient can shed light on whether particular psychiatric drugs will be effective and whether there is a higher risk of adverse events from those drugs for that individual. Psychiatrists can tailor their treatment plan to each patient based on his or her pharmacogenetic markers, which include genetic mutations that predict alterations in how the underlying neurons and synapses function, and the rate that a patient metabolizes medications, to help avoid issues such as lack of effectiveness, drug-resistance and drug interactions. Its a more objective, evidence-based guidance system to help doctors select the right medication for their patients.
Preparing For The Test
First and most importantly, don’t stop taking your medications or reducing the dosage unless you are doing so under the guidance of your physician. This is true even if you are concerned about false positives.
Even short-term interruptions in medication can have serious consequences for the treatment of your condition, not least of which is antidepressant discontinuation syndrome . Discuss any concerns you have with your mental health provider so you can take the drug screen safely and without stress.
It is also important to remember that antidepressants aren’t the only drugs that can trigger a false positive drug screen. Others include:
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Why Is Pharmacogenetics Important
When initiating drug therapy to treat a particular condition, healthcare practitioners typically prescribe one of several appropriate drugs. Dosages and timing of drugs are usually based upon the anticipated rate of metabolism and clearance from the body in the average person. They prescribe a “standard” dose based on factors such as weight, sex, and age. Clinically, however, each person responds uniquely to treatment and healthcare practitioners must make adjustments. For example, the healthcare practitioner may adjust the drug dose or switch to a different therapy, depending on whether the person’s condition is responding to the medication and whether the individual is experiencing unpleasant or dangerous side effects. Sometimes a person may find that a treatment that has been working well suddenly causes symptoms when that person starts taking an additional drug.
The concentrations or effects of some drugs are monitored with blood tests and the drug dosages may be increased or decreased to maintain the drug level in an established therapeutic range. Follow-up of drug concentration is called therapeutic drug monitoring. If changing the drug dose is not effective in treating or controlling the person’s condition, or the person still has side effects, then the person may be given a different drug.
How Much Does Genesightrx Cost
The initial consultation with the psychiatrist to determine if GeneSightRxTM is appropriate will be billed to insurance or can be paid by the patient separately from the test costs.
Currently, Lindner Center of HOPE patients are billed for the test by AssureRx. The AssureRx Health Billing Department will file insurance claims on the patients behalf. Please navigate to www.assurerxhealth.com for more further details.
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Ptsd Affected Treatment Response
In supplemental material, the researchers noted that the presence of PTSD in patients had a profound negative impact on remission from depression. Basically, the patients with PTSD responded poorly to antidepressants. We know from the literature that PTSD doesnt respond well to antidepressants, Oslin says. The main psychotherapies for patients with PTSD, he points out, are cognitive processing therapy and prolonged exposureboth widely used in VA.
One of the special ways that we did this study is as a pragmatic study in frontline clinical practices, Oslin says. We used clinicians and their patients. The providers all had to say that the patients were being treated for depression. But they could have had comorbidities, and many of them had comorbid PTSD, which had a big influence on treatment outcomes in a negative way.
For providers who would like to do pharmacogenomic testing in the future, the burden is low across the board, says Oslin. Theres no risk to patients in getting the test.
The costs actually are very low because the results can be used over the patients lifetime, Oslin says. So youre not talking about a test that has a shelf life of only five minutes. And theres really no risk to getting the test. Youre just getting the cheek swab or a blood test. Cost is low, risk is low, and the population benefits are probably low. But overall, this test likely benefits some patients substantially.
How Soon Can These Drugs Be Detected
How soon a drug can be detected and how long it remains present in your saliva depends on the drug being tested for.
Here are some of the most common substances checked for during a mouth swab drug test and how soon they can be detected in your saliva:
- Benzodiazepines: Also known as “benzos,” some drugs that fall under this category can be detected for up to 10 days after theyve been used. However, a benzodiazepine such as Ativan gets metabolized more quickly by the body and may only be detectable for around five days.
- : A mouth swab test can detect THC in your system as soon as 24 hours after consumption.
- Opiates: Most opiates such as heroin are detectable through saliva for about 24 to 36 hours after theyve been consumed.
- MDMA: More commonly known as ecstasy or molly, MDMAs can be detected through your saliva as soon as an hour after theyve been consumed. However, these substances pass through the bodys systems quickly and become almost undetectable 24 hours after consumption.
- Methamphetamine: Methamphetamine can be detected using a mouth swab drug test as soon as ten minutes after it has been used. It can remain detectable for up to four days later, especially with frequent users of the drug.
Although convenient, mouth swab drug tests do suffer from one serious disadvantage. They have a shorter testing time range than other methods of drug testing. This means that several drugs become undetectable in the saliva just a few days after theyve been used.
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Genetic Test Identifies Best Antidepressant
May 07, 2018
NEW YORK Patients with major depressive disorder in whom initial antidepressant therapy fails do better the next time around if their medication selection is guided by pharmacogenomic testing, according to results of the largest-ever pharmacogenomics clinical study in depression.
In the study, patients with treatment-resistant MDD were 30% more likely to respond to treatment and 50% more likely to achieve remission when their medication selection was guided by the GeneSight psychotropic genetic test.
The study was presented here at the American Psychiatric Association 2018 Annual Meeting.
Coming To A Pharmacy Near You
In Chicago, Boise, and Philadelphia, 28 Albertsons drug stores are offering the Genomind test, according to Kimberly Hecht, a patient care services coordinator with Albertsons who leads the project.
She told Business Insider that mental health became a focus at the pharmacies she oversees when they began offering medications for drug addiction. Plus, because Albertsons’ pharmacies are open longer and on more days of the week than others nearby, they sometimes function as a default mental health provider, Hecht said.
“It just made sense with what we were offering and also because of our position in the community,” Jennifer Rapley, a marketing manager with Albertsons who works closely with Hecht, told Business Insider.
The project is currently in a pilot phase, but Genomind hopes to eventually offer its gene test in all 1,760 Albertsons-owned pharmacies throughout the country, JAMA reported this month.
But some components of the Albertsons program such as how pharmacists determine whether a patient is a good candidate for the test and how it evaluates whether the results are effective remain hazy.
For example, a patient does not have to have a history of using antidepressants to be offered the test, Hecht said.
“Typically it’s going to be patients who’ve tried a couple different things and it’s not working, but we kind of leave it up to our pharmacists’ professional judgment,” she said.
That makes Schatzberg wary.
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Remission Of Depression Symptoms
Total remission is the primary goal when treating patients with depression, as advised by the experts consulted for this review. Figure 2 summarizes results from the two studies that reported on patient remission. In both studies, patients were considered to be in remission when they achieved HAMD-17 scores < 8, QIDS-C16 scores < 5, and PHQ-9 scores < 5.27,29
Insurance Coverage For Genetic Testing
Insurance coverage for genetic testing may vary depending on your insurance plan and personal history. You or your doctor may be required to submit documentation proving that you have a certain diagnosis or have experienced difficulty finding the right medication. It may be helpful to ask your healthcare provider for the specific procedure and medical billing codes for the lab tests theyd like to order before calling your insurance company about coverage. If your insurance doesnt cover the cost, check with the genetic testing company to see if they offer any payment assistancethese tests can cost a few hundred dollars.
Treating mental illness usually involves a combination of medication, psychotherapy, and psychoeducation. So its important to participate in other kinds of treatment and self-care activities while taking medication. Your diet, sleep, exercise, and other factors can also play a role in your mood and how your body responds to medication. As your body ages and develops, you may also find that medications will need to be adjusted by your doctor.
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Talk To Your Doctor About Other Medications
If possible, you may want to talk to your doctor about trying a different type of selective serotonin reuptake inhibitor that won’t produce a false positive. For instance, Prozac or Zoloft may produce a false-positive result, whereas Paxil , Celexa , and Lexapro do not.
If you’re using an antidepressant to treat neuropathic pain, you may want to avoid taking Effexor XR and tricyclic antidepressants , which are types of antidepressants that may be more likely to produce a false positive. Instead, you may ask your doctor about Cymbalta , which has a very low risk of producing a false positive on a drug test.
If you are using an antidepressant as a sleep aid, avoid using Desyrel if possible. Remeron or sedative-hypnotics are alternatives that have less of a chance of producing a false positive on a drug test.
Of course, if a specific medication is working well for your depressionand you and your doctor agree it’s best not to change coursesbe sure to show any and all medications to the lab technician conducting your drug screening.
Who Is A Candidate For Genetic Testing And What Is The Procedure
Genetic testing is not just for people like William who have battled a nonresponsive medical regimenit can help people who are new to treatment determine in a more rapid and targeted fashion what medication and dosage is right for them, possibly avoiding the roller coaster ride of medication resistance or a plateau in symptom relief down the road. Genetic testing addresses a variety of disorders apart from depression, anxiety and Bipolar Disorder, such as: Attention Deficit Hyperactivity Disorder , Post -Traumatic Stress Disorder , Schizophrenia, Obsessive-Compulsive Disorder , autism, chronic pain and substance abuse.
You can be tested in your doctors office by taking a swab on the inside of your cheek, which is completely painless. The results usually takes 3 to 5 days to process. Genomind accepts all commercial insurance, Medicare, and most Medicaid plans, and works with patients based on their financial needs to make the test affordable.
A candidate must understand the risks of basing a treatment plan in part on the results of genetic testing. This technology does not fully replace the trial and error process, and results are not always straightforward. Disclosure of a genetic finding that reveals a major health issue also could have emotional consequences for a patient with an existing psychological fragility, but the benefit of being able to see several steps ahead using information from your personal neurobiological profile outweighs those risks.
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Genetic Tests For Depression Treatment Aren’t Effective Experts Say
ByNicoletta Lanesepublished 21 August 19
Dozens of companies invite consumers to spit in a tube to determine which antidepressant is right for them. There’s little evidence that these tests work.
Dozens of companies invite customers to swab their cheeks, spit into a tube, and find out which antidepressant is right for them.
Their products pharmacogenomic tests aim to predict how someone with depression will respond to medications based on that person’s genetic makeup, sparing them from the trial-and-error that often comes with selecting an antidepressant. Some companies, such as Color Genomics, require that a physician order the test. But many testing products can be ordered by consumers directly. A handful have been FDA-approved.
Though psychiatrists see the potential of these tests, many doctors warn that those on the market aren’t up to snuff. They say that hundreds of genes may affect depression, and that studies demonstrating the benefit of these tests are lacking.
Genetic Testing Could Help Patients With Depression
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A new VA study found that pharmacogenomic testing can help providers avoid prescribing antidepressant medications that may have undesirable outcomes. Pharmacogenomics is the study of how genes affect the bodys response to drugs.
The researchers also found that the patients who underwent genetic testing had more positive outcomes, compared with patients in usual care. Over 24 weeks of treatment, the group with genetic testing had in a drop in depression symptomswith a peak effect at 12 weeks. Each patient in the study had major depressive disorder. Symptoms of that health condition include insomnia, loss of appetite, feelings of sadness and depression, and thoughts of dying by suicide.
The study results appeared in July 2022 in the Journal of the American Medical Association.
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What To Expect Before During & After Mouth Swab Tests
Before taking a saliva drug test, its important to avoid eating or drinking for at least 10 minutes. During the test, youll need to keep your mouth open to allow the technician to swab the inside of your mouth. After the test, the sample should be protected from contamination and stored properly until it can be assessed.
Once you receive the test results, youll want to check the name and identification number to verify that it is your test. If you doubt the results of your test, you can ask to review the test results and/or undergo a follow-up test.