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.
Review Of Genesight Privacy & Data
Is GeneSight safe? Myriad Genetics has a Notice of Privacy Practices that explains what personal information the company collects from patients. According to this notice, GeneSight collects email addresses, names, addresses, phone numbers, etc. It also collects personal and family health history, insurance, employment, and demographic information.
The company uses data for promotional and marketing efforts, such as social media advertising. Patients can request that their data be deleted.
Ready To Offer Your Patients The Genesight Test
STEP 1Get started by filling out this form or calling us at . A representative will help register you to offer the GeneSight test.
STEP 2Once registered, place your order on myGeneSight.com.
STEP 3You or a member of your staff collect the patients DNA sample with a simple cheek swab OR your patient collects the sample at home using our patient collection kit.
STEP 4Your patients sample is sent to our lab for analysis. After the sample is received, results are typically available in about 2 days.
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Potential Benefits Of The Genesight Test
The test holds potential for notable benefits, namely: predicting metabolic responses as well as whether a person is likely to experience symptomatic improvement on a particular medication.
The Genesight Psychotropic Report
Fewer than 50% of patients with depression respond to their first prescribed medication and with each failed medication trial, their treatment intolerance increases. The GeneSight report uses color-coding to show which medicines may be more likely to work for a patient and which may require dose adjustments, may be less likely to work, or may have an increased risk of side effects based on the patients genetic makeup.
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The Science Behind Genesight
The company claims that its test is backed by more scientific evidence than any other pharmacogenomics test. It mentions seven clinical studies on its homepage.
Pharmacogenomics refers to the use of genomic sequencing to produce more effective prescriptions. This branch of science claims that genes may affect the way some medicines work in the body. For example, according to this study, while most patients with major depression respond to antidepressants, 10-30% show little to no improvement. In this case, GeneSight seeks to analyze gene-drug interactions to identify the most effective psychotropics.
This field has been growing for quite some time, and the research supporting the use of genetics to prescribe psychotropics for certain conditions has been debated. There is only scarce evidence for some mental disorders, but for others, there has been more success connecting genomics to drug metabolism.
A 2015 review by The Carlat Report of GeneSights clinical evidence concluded that the evidence at that point was not entirely convincing, but intriguing. The author suggested that psychiatrists reserve the test for patients who have unsuccessfully tried multiple medications.
However, more recently, GeneSight has published more studies. Sponsored by Assurex Health Inc., GeneSight completed a 12 Week, Randomized, Double-Blind, Controlled clinical trial in 2017.
A similar service, Genomind, also focuses on genetic testing to help medical providers treat mental health disorders.
Genesight Trials: Determining The Accuracy Of The Test
The GeneSight testing is undergoing trials among psychiatrists to determine its accuracy. One psychiatrist ended up sharing how the trials are being conducted. Anthony Rothschild, a psychiatrist at UMass Medical School said, For half the patients, I will be guided to strongly consider the green light medicines identified by the test for the other half I will not use the test, just my own judgment, to prescribe for the first 12 weeks.
He then stated, After 12 weeks, whether the person is better or not, I will share with them the results of the test. If theyre better, fine. If theyre not better and I havent been using the test, I will use it. Or if I was using the test and theyre not better, I will consider another green light medicine for them to try. The accuracy of the testing is currently unknown, but more data will likely surface as GeneSight trials progress.
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Genesight: Genetic Test Predicts Best & Worst Antidepressants For Each Person
Its no secret that depression is becoming one of the biggest epidemics in the United States and throughout the world. Many people suffer from mental illnesses, but depression is a condition that seems to affect everyone at some point in their lives. Unfortunately there is no pill that will cure depression, but there are various medications that help individuals manage their depressive symptoms.
Instead of making lifestyle changes such as eating an optimal diet for mental health or pursuing natural cures for depression, most people seek out the help of antidepressants. There is nothing wrong with taking an antidepressant medication if you are on your last leg and no lifestyle changes have helped. The problem with medications is that many people end up playing antidepressant roulette or hopping from one drug to another and getting unsatisfactory results.
Study Yields Positive Results On Accurate Medication Dosing
“I do think the results favoring a positive effect on treatment, although small, will encourage providers to test patients and get this genetic information.”
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.
Dr. David Oslin
Dr. David Oslin, director of VAs VISN 4 Mental Illness, Research, Education, and Clinical Center , led the study. He thinks the results will encourage providers to consider using pharmacogenomic testing, with patient consent, to help drive treatment decisions.
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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
Proportion of Patients With Remission of Depression Symptomsa,b
One study, Hall-Flavin et al,27 also conducted sensitivity analyses using the intention-to-treat analytical strategies of expected maximum and last observation carried forward they found results to be consistent and/or stronger in favour of guided therapy than those reported here. There was a statistically significant benefit in depression remission for GeneSight compared with usual treatment when depressive symptoms were assessed using QIDS-C16, but no significant difference when using HAMD-17 or PHQ-9. This was based on very low quality evidence , as the findings were inconsistent with respect to the effectiveness of GeneSight to improve remission from depression, and they depended on the scale used to measure depression .
Clinical Need And Target Population
Individual variations in people’s genetic code may cause them to respond differently to medications. They may experience differences in metabolism , differences in mechanism of action , and individual adverse effects. For example, a person classified as a poor metabolizer because of differences in their genetic coding may have a lower enzyme response rate and metabolize a medication more slowly.9,10 This would lead to higher concentrations of the medication in their system than a typical metabolizer would have, and thus, potential adverse effects. Ultra metabolizers are less likely to experience side effects that lead to discontinuing the medication, but they may need a higher dosage to achieve a noticeable benefit.6
Genome-wide association studies have attributed as much as 42% of the variation in response to antidepressants to individual genetic differences, and other studies have demonstrated correlations with ethnicity and ancestral variations.1012 It is believed that prescribing clinicians who know a patient’s genetic predisposition could better target therapies, reduce the risk of adverse effects, and minimize the use of the health care system, services, and costs.13
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The Focus On Metabolizing The Drug
In recent years, pharmacogenomic testing has received greater attention as a tool to personalize medication selection and is often used to treat patients with health conditions such as cancer and heart disease. Many in the medical community hope the testing can also be helpful in treating people with major depressive disorder. Research has been limited, however, on demonstrating improved clinical outcomes.
Currently, most of the pharmacogenomic testing focuses on a variant in the genes that encode hepatic CYP450 enzymes, a pathway that metabolizes drugs in the liver. Oslin and his team used a commercial battery of genes that focused on the CYP450 system. The battery tested eight genes, six of which test for variants in enzymes of the liver.
What do genes have to do with antidepressants?
The genes we tested dont actually relate to depression, Oslin says. They relate to how a person metabolizes the drugs once theyre in the body. Some of these genes will cause the medications to metabolize much faster than normal. Others will cause the drugs to metabolize much slower than normal, which means youll end up with a lot of medication in your body.
A drug-gene interaction is an association between a medication and a genetic variant that may affect a patient’s response to drug treatment. Having that information helps the provider select the appropriate dosage for a specific patient.
Access To Myriad Genetics Genesight Test Improves Depression Remission Rates In Largest Ever Mental Health Pgx Randomized Controlled Trial
Study showed PGx testing helps clinicians prescribe fewer medications with gene-drug interactions
SALT LAKE CITY, July 12, 2022 — Major Depressive Disorder remission rates were significantly improved when clinicians had access to GeneSight® Psychotropic test results from Myriad Genetics, Inc. , according to a new nationwide study of nearly 2,000 veterans conducted by the U.S. Department of Veterans Affairs .
The PRIME Care study is the largest pharmacogenomic randomized controlled trial ever conducted in mental health. Results of the study were published in the July 2022 issue of the Journal of the American Medical Association . The VA independently conducted and funded the study. Myriad Genetics provided the GeneSight tests for the study.
The number of veterans suffering from depression is a serious mental health issue. The PRIME Care study showed that veterans are more likely to achieve depression remission when GeneSight test results are available to inform medication treatment, said Paul J. Diaz, president and CEO, Myriad Genetics. We thank the VA and the investigators for conducting this important research. The results demonstrate how veterans may be helped by clinicians who provide personalized medication treatment and how such treatment can help make a positive impact on their lives, their families lives, and their communities.
_______________1 U.S. Department of Veterans Affairs.
About the PRIME Care Study
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A Trick Your Doctor Might Not Know About
Can you just find out the blood level of a particular psychiatric medication that youre on? Yes, you can. All psychiatric medications had to establish a therapeutic blood level reference range prior to being approved by the FDA. So, yes, you could have your doctor order a test to see if the blood level of a psychiatric medication that you are taking is in the normal reference range. It may take some searching for your doctor to find the correct laboratory testing code to order the test, but you should be able to obtain a blood level of any psychiatric medication that you are on. And, you could do this whether or not you first obtained genetic testing.
Will The Testing Reveal Which Medication Will Work For Me
Most doctors and patients wish the answer to this question was yes. Unfortunately, some genetics companies will prepare reports that make it look as though this is the case. There is currently only one test that demonstrates responsiveness to an antidepressant , and it mainly shows your likelihood of response to just one antidepressant medication, Lexapro . This test is not foolproof but it is helpful to some extent. Otherwise, there is limited research to show that genetic testing will reveal what medication will work for you.
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Lets Look At Genetic Testing For A Common Antidepressant Wellbutrin
Wellbutrin is mainly broken down through two enzyme systems in the liver, CYP2B6 and CYP2D6. What would happen if there were abnormalities in the genes that encode the enzymes of those two systems? Typically, if the genes that encode those enzymes are abnormal, the enzymes wont work. If the enzymes dont work, then your body will have a hard time breaking down or clearing Wellbutrin from your body. As you keep swallowing a Wellbutrin tablet each day, your blood levels will climb to toxic levels. So, what are the risks of having a toxic level of Wellbutrin? One of the main risks is a seizure. Wouldnt you like to know if your genes are normal or abnormal? On the other hand, what would happen if you had extra copies of the genes that encode those two enzymes? Well, you would have extra enzymes to break down those medications, so even though you would be taking Wellbutrin each day, you would be unable to get your blood level of Wellbutrin high enough for it to help your depression.
What Is The Main Reason For Genetic Testing For Psychiatric Medications
Genetic testing shows how the liver breaks down psychiatric medication, through different enzyme pathways. Most medications are broken down through two to five of these enzyme pathways. If one of these pathways has an abnormality in the genes which encode the enzyme, the enzyme wont work. Therefore, the medication will not be broken down and removed from the body as quickly as predicted, and the blood level of the medication will rise to higher levels and possibly cause more side effects or toxicity. At the other end of the spectrum, if there are extra copies of genes that encode these enzymes, the extra enzymes will break down medications very quickly, preventing a person from benefiting from the medication because they cant get the medication up to a therapeutic blood level.
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Genesight: Genetic Testing For Mental Health Treatment
When your loved one is battling anxiety, depression, or other mental health conditions, they shouldnt have to battle their medication, too.
It can be a horrible, helpless feeling when you see a family member or friend repeatedly struggle with trial and error, trying to find a medication that relieves their mental health symptoms without causing debilitating side effects.
Thats why we have been sharing information about the GeneSight test, which helps doctors, psychiatrists or nurse practitioners understand how your loved ones unique DNA may affect their outcomes with the medications they take. This insight can be used to inform treatment and may improve their chances of finally feeling like themselves again.
The GeneSight test must be ordered by a clinician authorized to prescribe medications. The test is a simple, painless swab of the inside of your cheeks. The test can be taken in a clinicians office or ordered by a clinician to be taken at home.
More than 1 million patients have taken the GeneSight test.
If you think genetic testing could be helpful for you or your loved one, talk to your healthcare provider about the GeneSight Psychotropic test. You can find a clinician who offers the GeneSight test near you by visiting