Genetic Testing for Psychiatric Medication in Baltimore

I am a big fan of genetic testing and frequently utilize it in my practice. It allows for your unique genetic profile to be considered in medication decision-making. The DNA testing of relevant genes reveals how your body processes medication, and how well various medications may work for you. As the lead author of an article in The American Journal of Human Genetics, I have particular expertise in this area.  Expert interpretation of the results beyond the medication summary page is very important. The testing is easily done in the office by swabbing the inside of the cheek with Q-tips, and then sending out the sample for analysis.

Studies suggest that the testing provides significant advantages in getting to the correct medication sooner and yielding better outcomes. This includes findings just released from a study that evaluated 1,200 patients with Depression to assess the impact of the genetic testing on treatment response. The patients who had the benefit of genetic testing were more likely to achieve response and remission compared to treatment as usual. In addition, scores on a well-regarded depression rating scale improved significantly more for the group that had the testing. Lastly, the improvement in remission, response, and symptoms continued throughout the 24-week study period, demonstrating the durability of the benefit.

There is still not full consensus on if and when the testing should be utilized. Often, hesitation is based on anecdotal cases, where clearly the prescriber should have been thinking first about what medication would be the best choice for the patient’s condition and symptoms and then referring to the testing to further inform the decision.

I have seen genetic testing misinterpreted, or otherwise not utilized properly, in a variety of different ways. I have seen where only the medication summary page of the testing is used, and not the totality of the genetic information provided (including when it appeared there wasn’t an understanding of all the genes tested and the meaning of their variations). This misses out on medications that may be the most appropriate for a patient. For example, a medication that ends up in the “moderate gene-drug interaction” category, and therefore not used, may actually be the best one for the patient’s symptoms and simply require a dose adjustment or closer monitoring.  On the other hand, as alluded to already, a medication may be chosen solely based on the genetic profile without taking into account the patient’s specific clinical condition, symptoms, or past medication history.

I use genetic testing often because I find it provides very important personalized information about how medications will work and be processed uniquely for an individual. It very commonly explains intolerances or lack of effect of past medication trials. When ordering pharmacogenomic testing, I discuss how we are going to use the test, and when analyzing the results I spend as much or more time looking at the raw genetic findings to add my own expertise to the interpretation. As another example, sometimes the testing will yield a caution that blood levels of a medication may be too high because the enzyme that is responsible for breaking down that medication is slow (known as a poor metabolizer). Typically this is accurate, but I often will be aware of a study that has actually measured the blood levels of this particular medication in this circumstance that demonstrated that no dose adjustment is necessary (for various reasons that are too “in the weeds” to review in this post!).  For these reasons, I would prefer that the categories used in the summary reports be changed from “Gene-Drug Interactions” to “Gene-Drug Considerations.” Again, I find genetic testing to be extremely helpful and frequently utilize it in my practice. I would be happy to discuss this with you at an evaluation!

The best of health,

Dr. Ranen


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