Renowned biochemist and Nobel Laureate Paul Berg said, “I start with the premise that all human disease is genetic.” Indeed, advances in medicine have seen the transformative utility of genetic testing for cancer and other medical conditions. However, genetic testing has only recently seen utilization in psychiatry. The complexities of our brain have long eluded precise examination and treatment.

For people with mental illness and their loved ones, the journey to better health can be a long and troubled passage. Patients and their caregivers can face stressful days and restless nights, filled with profound physical and emotional challenges.

For the more than 46 million Americans whose lives are impacted by mental health conditions¹, the burden can be costly as well. According to an editorial in the American Journal of Psychiatry, serious mental illnesses cost patients more than $193 billion per year in lost earnings.²  The emotional cost is boundless.

Genetic testing can reduce the pain of trial and error

The financial and emotional strain of prolonged treatment failure worsens the struggle for many people with mental illness. Unfortunately, this is an unintended consequence of psychiatric practice that often utilizes an informed trial-and-error process in selecting medications.

Going through many iterations of medicines unsuccessfully often deepens a patient’s sense of despair and hopelessness. For some patients, it may take months or years to get to the right regimen.

I’ve witnessed the impact on patients and their families firsthand. It’s not uncommon for our practice to see about 40 new patients a month, 70% of whom have been treated by between one and thirteen other doctors.

These patients have suffered through many medication missteps. I even had one patient who had been on fifteen different psychotropics in the last three to four years, none of which helped, and some of which made him worse.

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The challenge of treatment resistance

Shortening the time it takes to get a patient on the right medicine, or combination of medications can do more than just treat their condition. It can also help avoid the risk of further emotional and cognitive decline and even prevent dementia or suicide.

However, achieving greater precision in prescribing drugs for mental health conditions can be a daunting task for any clinician, particularly when it involves treatment-resistant patients who go through multiple rounds of failed medications.

Addressing the challenge of treatment resistance is critical to stemming the burgeoning mental health crisis in the U.S. The Centers for Disease Control and Prevention predicts that 50% of all Americans will be diagnosed with a mental illness or disorder at some point in their lifetime.³

What makes this forecast more stark is the fact that an estimated two out of three people with depression will be prescribed an ineffective medication at the start of treatment. And, one in three people will become treatment resistant. This is according to a study published in the American Journal of Managed Care. The same study also showed that people who are resistant to treatment will pay 40% more in healthcare costs.⁴

Embracing innovation in mental health care

To improve the process of prescribing drugs for mental health conditions, doctors are increasingly utilizing new technologies like genetic testing to enhance their decision-making. Genetic testing brings much-needed innovation to the classic approach to treating psychiatric conditions that rely on treatment guidelines, physician training, population-based studies, and trial-and-error.

It augments diagnostic-specific treatment strategies and personalized patient data, such as symptom profile, family history, and past responses to medications, with precision medical information that is based on a patient’s personal genome. Since each person’s response to medicine can be impacted by their genetic variations, genetic testing provides actionable information that narrows the choice of medication for each individual patient.

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While no single test enables a psychiatrist to prescribe with surgical precision, genetic testing makes us more precise prescribers. It identifies which drugs that are more likely to work and which are more likely to have unwanted side effects. This can shorten the time it takes to prescribe the most effective medication. Each day saved is one less day of emotional torment for patients and their loved ones.

Genetic testing and mental health: What you need to know

Genetic testing is driving a paradigm shift in the personalized treatment of mental illness. As more and more doctors rely on genetic testing to support drug selection for mental health conditions, here are answers to some commonly asked questions that may be helpful for patients:

• How is a genetic test administered?

The test is conducted in a doctor’s office and requires only a simple swab of the inside of your cheek with a cotton swab.

• What does it test for?

Genetic testing in mental health analyzes patients’ genes from two critical standpoints:

1. 1. the effect a drug has on their body
   2. how their body would metabolize that drug.

• How many genes and medications are analyzed?

The numbers of genes and medications that are covered vary depending upon which commercially available genetic test is utilized. In my practice, I have worked extensively with the Genomind test. It covers 24 genes and 130 FDA-approved medications (36 of which are labeled with genetic guidelines) that are specific to a range of mental health conditions.

These include:

• • depression
  • anxiety
  • obsessive-compulsive disorder (OCD)
  • attention-deficit/hyperactivity disorder (ADHD)
  • bipolar disorder
  • post-traumatic stress disorder (PTSD)
  • autism
  • schizophrenia
  • chronic pain
  • substance abuse

• How are test results reported?

Following lab processing, genetic test results are provided to your doctor in 3 to 5 days. Healthcare professionals utilizing the Genomind test can also arrange for a free consult with the company’s pharmacogenetic experts to discuss the results and help interpret the findings.

• Is the test reimbursed by insurance?

Genetic testing can be submitted for reimbursement to commercial and third-party payers, Medicare and Medicaid, and some other government programs. Many private companies are also providing access to genetic testing through employee benefit programs.

Evidence of positive outcomes

Genetic testing is already proving to be a valuable asset in helping doctors improve patient outcomes in mental health care. Published studies have brought forward evidence of its utility in the doctor’s toolkit for guiding treatment strategies for various conditions.

Among these is a study published in Primary Care Companion for CNS Disorders that examined the effectiveness of pharmacogenetic testing to guide treatment in patients with mood and anxiety disorders. It found that 87% of patients (685 total) reported measurable improvements on multiple analyses of their symptoms, adverse effects, and quality of life over three months.⁵

Another independent study published in the Journal of Depression and Anxiety examined 817 patients with mood and anxiety disorders whose treatment was guided by a commercially-available genetic test. The researchers compared their outcomes with those of matched control patients whose treatment did not involve pharmacogenomic testing.

The results showed the patients who used the testing service had 40% fewer emergency room visits and 58% fewer inpatient hospitalizations in the six-month period following testing. Moreover, healthcare utilization costs decreased by $1,948 per patient in the same six-month period.⁶

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Final thoughts

Pulitzer Prize-winning author Dr. Siddhartha Mukherjee has said,

“In the twenty-first century… we are constructing a new epidemiology of self: we are beginning to describe illness, identity, affinity, temperament, preferences – and, ultimately, fate and choice – in terms of genes and genomes. The influence of genes on our lives and beings is richer, deeper, and more unnerving than we had imagined.”  

As the integration of genetic testing into mental health care continues, we still have a lot to learn. Like any frontier science or disruptive technology, there has been a fierce debate. But mental illness is a global crisis that shows no signs of abating. As healthcare practitioners, now is the time for us to embrace innovation in order to improve upon our efforts to help patients.

Genetic testing offers a path forward to partner with our patients with a more personalized, precise approach. To fully empathize with their plight, we must leave no stone unturned in shortening their time to achieving a full recovery.

For more information on the pharmacogenomic test we use in our practice, visit www.genomind.com.

Author’s financial disclosure: “Genomind and Potomac Psychiatry have an ongoing marketing collaboration aimed at raising visibility for Genomind pharmacogenomics services and Potomac Psychiatry’s Genetic Testing Consultations.”

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References

1. NIMH Report: Prevalence of Mental Illness (2017)

2. Insel, T.R. (2008). Assessing the Economic Costs of Serious Mental Illness. The American Journal of Psychiatry. 165(6), 663-665

3. https://www.cdc.gov/mentalhealth/learn/index.htm

4. Fagerness J, Fonseca E, Hess GP, Scott R, Gardner KR, Koffler M, Fava M, Perlis R, Brennan FX, Lombard J Pharmacogenetic-guided psychiatric intervention associated with increased adherence and cost savings American Journal of Managed Care 2014 May; 20(5):e146-5

5. Brennan FX, Gardner KR, Lombard J, Perlis RH, Fava M, Harris HW, Scott R. Prim Care Companion CNS Disord. 2015 Apr 16;17(2). doi: 10.4088/PCC.14m01717

6. Perlis R et al. Pharmacogenetic testing among patients with mood and anxiety disorders is associated with decreased utilization and cost: A propensity‐score matched study. Depression and Anxiety, 2018