Summary
We often see questions posted on social media sites or get questions from our patients or prospective patients that want to know more about pharmacogenetic testing. Below, find nine of the most frequently asked questions answered!
Have you heard about something called pharmacogenetic testing? Also known as testing genes for mental health medications? Below, find nine of the most frequently asked questions answered!
What is pharmacogenetic testing?
Pharmacogenetic testing is typically accomplished by taking a swab of the inside of your cheek. The sample is sent to one of several companies that does this type of testing. Once analyzed, you will typically get a report that tells us a few different things about how medications work for you, such as:
- How your body metabolizes some medications
- How your body responds to some medications
It’s important to remember that not all medications we use have genetic markers. Some of the tests out there will make it seem like one of these medications would be a great choice, but this is because they don’t test for any of the genes that would tell us anything about how you metabolize or respond to the medication.
What is the best pharmacogenetic test for me?
We primarily use Genomind for pharmacogenetic testing, but we can use some other companies upon request. You want to balance the cost, insurance coverage, what the test covers, and if what is covered is well-evidenced. This is an individual conversation based on your needs.
There is one test that we do not use because we have concerns about how the test does reporting. The report they use is overly simplistic. This tends to lead to many anxious moments for patients or family members when they are on a medication that is shown in colors with a negative connotation which means a dosage adjustment may be needed rather than the medication being harmful.
Will pharmacogenetic testing tell me the best or right medication for me?
Pharmacogenetic testing does not help with diagnosis. Diagnosis is the most important piece of choosing the right medication. Pharmacogenetic testing can help you determine which medication might be ideal based on how you metabolize medication.
Does pharmacogenetic testing help in choosing an ADHD medication?
Pharmacogenetic testing is much better at helping with antidepressants. Amphetamines such as Adderall or Vyvanse are metabolized in part by markers that all of the commercially available tests do test for, but methylphenidates, such Ritalin or Focalin, do not have as clear markers. One company has recently started testing a unique marker not tested by any other companies. Thus far, the research used to support this test was funded by the company that markets the test. We reserve judgment until there is additional research available.
If I had testing done by someone else, do I need a new test?
Not necessarily. Depending on how long ago the testing was done, it may or may not include information for all the current genes commonly tested. Also, it may not have markers for specific newer medications or side effects. We are happy to look at it; it may be perfectly adequate. We don’t want you to have more tests than needed.
Is there any other kind of test that tells me how medications work?
Although pharmacogenetic tests are well marketed right now, we can find out for sure how much medication is on your system right now with a blood test for most antidepressants and mood stabilizers. We can also test for markers for medication metabolism with a blood test, though insurance coverage for these tests may also be problematic.
What if the test says that my medication shouldn’t work, but it does? Does that mean I’m getting placebo effect?
Genetics is a complicated field, and there’s often more than one gene involved in any specific trait. I’ve used one of the commercially available genetic trait tests. If you were to meet me in person, you might be struck by how short I am. However, the test I used suggests that I should be of average height. What happened? Did my parents starve me as a kid?
Of course not. Although my parents were of average height, there’s plenty of members of my extended family that are either quite short or tall. Many different genes are involved in height, and the same can be said about medication response. While pharmacogenetic testing tells us about some common genes, there’s still a limit to what those tests tell us. So you might not be getting a placebo effect at all. There may be a factor that’s not evident in the testing.
Are these tests always accurate?
Not always. As with most things, there is room for error. To minimize errors you do want to make sure that the sample is taken correctly (for example, not eating or drinking before the test, so that the sample isn’t contaminated) and is processed promptly. To help with this, you’ll want to ensure the company has all the information they need to process your sample before it is taken. There are some issues with different results between different companies, which we want to be aware of. This is also why we encourage checking the blood levels of certain drugs before making changes based solely on the pharmacogenetic test.
If I can’t work with you, what should I look for in a provider that does pharmacogenetic testing?
You want to ensure that your provider has the skill to interpret the report even without gimmicks like traffic light colors or up-and-down arrows telling them which medication is “best.” Run if your provider insists that one of these tests be done on your first appointment. These tests are never required. These tests can be helpful, but they should always be voluntary.