Genetic testing is a remarkable technologic advancement that has significantly improved our ability to successfully treat patients. At Potomac Psychiatry, I include Genomind’s pharmacogenetic test in each new patient evaluation, and in the past two years, I have performed Genomind’s pharmacogenetic testing on hundreds of patients and discovered many benefits to genetic testing.
1. Patients like the test.
The results of pharmacogenetic (PGx) test help them to understand why certain medications may work to help them feel better and why others may not. When I first interpret the meaning of the genetic variations to our patients, many feel relieved knowing there is a scientific reason that their meds were not working for them. They are encouraged and hopeful that we have a new, scientific tool that can help us better predict what specific treatments will be best for them.
2. It takes out a lot of the guesswork.
For those coming to our practice for the first time, genetic testing helps us to avoid time consuming and costly trial-and-error approaches to medication management. A PGx test improves treatment outcomes by enabling us to select those medications more likely to alleviate symptoms and have fewer side effects.
3. It offers new hope for patients with treatment resistant, complex conditions.
I also see many new patients who have failed to adequately respond to prior treatment elsewhere. For this more challenging population, pharmacogenetic testing helps me to prescribe a stepwise treatment approach that combines both psychotropic medications and supplements. Based upon the specific genetic variations, we can then develop a combination therapy protocol that optimizes treatment response in most patients, at times resulting in a full remission of symptoms.
One Patient’s Journey to Relief
One of my patients, “Alan,” is a good example of how genetic testing can dramatically improve a patient’s treatment outcome. He had a longstanding history of depression and drug-induced hypomania due to Selective Serotonin Reuptake Inhibitors (SSRIs). Prior to seeing me, he had been unsuccessfully treated with several medications. He came to my office complaining of anxiety, depression, insomnia, and negative thoughts. I added Latuda to his Lithium and ordered laboratory tests. One month into treatment, his symptoms – including episodic anxiety, panic attacks, negative thinking, trouble paying attention, reduced memory, irritability, loss of appetite, and social withdrawal – had not improved at all, despite increases in Latuda and Lithium, drugs that “should have worked.”
Finally, we performed the pharmacogenetic test, which revealed genetic variations in the following genes; SLC6A4, 5HT2C, ANK3, COMT (VAL/VAL), MTHFR and CYP2D6 (ultra-rapid metabolizer). Based on these results, we added, and then slowly increased, Wellbutrin and Lamictal. Several weeks later, he reported that “I am doing much better and I’m getting things done. I am sleeping well and feeling more accomplished.” We then added Deplin, phosphatidylserine, and green tea to further “tune” his regimen and compensate for the effects of his genetic variants. Over time, he felt so much better that he was able to begin attending college classes again.
I am delighted to report that I routinely hear patients and their families describe their positive experiences with genetic testing and the resulting improvement in their quality of life. Because of these significant outcomes, I have become highly dependent upon PGx tests as an essential tool that enhances my ability to provide the best possible care. It is at the forefront of the emerging field of precision medicine.
*Prescription drug and other treatment regimens should not be altered without consulting a licensed clinician
**Learn more about MTHFR and mental health here.
About the Author
Dr. Bruce A. Kehr has served as Founder and President of Potomac Psychiatry since 1981. He has been repeatedly selected as a “Top Doctor” by Washingtonian Magazine, after polling more than 10,000 randomly selected physicians in the DC area, and asking them where they would send their patients and family members for treatment. Dr. Kehr is passionate about helping patients with anxiety, depression, obsessive compulsive disorder, life adjustment issues, and bipolar disorder. He is Board Certified by the American Board of Psychiatry and Neurology. Read more on his blog.
