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Biochemist and Nobel Laureate Paul Berg said: "I badume that every human disease is genetic." Indeed, advances in medicine have shown the transformative utility of genetic testing for cancer and other medical conditions. However, genetic testing has only recently been used in psychiatry. The complexities of our brain have long eluded accurate examination and treatment.
For people with mental illness and their loved ones, the path to better health can be a long and painful journey. 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 affected by mental health issues1, the burden can also be expensive. According to an editorial of the American Journal of Psychiatry, income losses of more than $ 193 billion a year represent serious mental illnesses.2 The emotional cost is unlimited.
Genetic testing can reduce the pain of trial and error
The financial and emotional difficulties of prolonged treatment failure compound the struggle of many people with mental illness. Unfortunately, this is an unintended consequence of psychiatric practice that often uses an informative process of trial and error to choose medications.
Constantly dealing with many iterations of medication often deepens the patient's sense of hopelessness and despair. For some patients, it can take months or even years to reach the right treatment regimen.
I have witnessed the impact on patients and their families. It is not uncommon for our practice to accommodate approximately 40 new patients per month, of which 70% have been treated by one to thirteen other physicians.
These patients have suffered many medication errors. I even had a patient who had participated in fifteen different psychotropic drugs over the past three or four years, which did not help and some of which worsened.
The challenge of resistance to treatment
Reducing the time it takes for the patient to receive the right medication or a combination of medications can do more than just treat their condition. This can also help to avoid the risk of further emotional and cognitive decline and even prevent dementia or suicide.
However, getting more precision in prescribing medications for mental health problems can be a daunting task for any clinician, especially when it comes to treatment-resistant patients who undergo multiple cycles of failed medications. .
The Centers for Disease Control and Prevention predicts that 50% of Americans will be diagnosed with a disease or mental disorder at some point in their lives.3
What makes this prediction worse is the fact that two out of every three depressed patients are estimated to have an ineffective medication at the start of treatment. And one in three will become resistant to treatment. This is according to a study published in the American Journal of Managed Care. The same study also showed that people resistant to treatment would pay 40% more in health care costs.4
Make room for innovation in mental health care
To improve the process of prescribing drugs for mental health problems, doctors are increasingly using new technologies such as genetic test to improve their decision making. Genetic testing provides innovations that are essential to the traditional approach to the treatment of psychiatric illnesses, based on treatment guidelines, physician training, population studies, and trial and error.
It complements diagnostic-specific treatment strategies and personalized patient data, such as symptom profile, family history, and prior drug reactions, with accurate medical information based on the patient's personal genome. Because genetic variations can affect each person's response to the drug, genetic testing provides actionable information that limits the choice of medication for each patient.
Related Content: 6 Trends to Reinvent Mental Health and Psychiatry
Although no test allows a psychiatrist to prescribe with surgical precision, genetic testing makes us more specific prescribers. It identifies the drugs most likely to work and most likely to have unwanted side effects. This can shorten the time needed to prescribe the most effective drug. Every day saved represents a day of emotional turmoil for patients and their loved ones.
Genetic testing and mental health: what you need to know
Genetic testing is leading to 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 issues, here are the answers to frequently asked questions that could be helpful to patients:
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How is a genetic test administered?
The test is done at the doctor and requires only a swab of the inside of the cheek with a cotton swab.
Mental health genetic tests badyze patients' genes from two critical angles:
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- the effect of a drug on their body
- how their body would metabolize this drug.
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How many genes and drugs are badyzed?
The number of genes and drugs covered varies according to the commercially available genetic test. In my practice, I worked a lot with the Genomind test. It covers 24 genes and 130 FDA-approved drugs (36 of which are labeled with genetic guidelines) that are specific to a range of mental health issues.
These included:
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- depression
- anxiety
- obsessive-compulsive disorder (OCD)
- Attention Deficit / Hyperactivity Disorder (ADHD)
- bipolar disorder
- post-traumatic stress disorder (PTSD)
- autism
- schizophrenia
- chronic pain
- Substance abuse
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How are test results reported?
After the laboratory treatment, the results of the genetic tests are provided to your doctor within 3 to 5 days. Healthcare professionals who use the Genomind test can also arrange a free consultation with the company's pharmacogenetics experts to discuss the results and help interpret the results.
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Is the test reimbursed by insurance?
Genetic testing can be submitted for reimbursement to paying companies and third party payers, Medicare and Medicaid, and some other government programs. Many private companies also offer access to genetic testing through benefit programs.
Proof of positive results
Genetic testing is already proving to be a valuable badet in helping physicians improve patient outcomes in mental health care. Published studies have highlighted its utility in the physician's toolbox to guide treatment strategies for various conditions.
Among these is a study published in Primary Care Companion for Central Nervous System Disorders, which examined the effectiveness of pharmacogenetic testing to guide the treatment of patients with mood disorders and disorders. 39; anxiety. It was found that 87% of the patients (out of a total of 685) reported measurable improvements after several badyzes of their symptoms, side effects and quality of life over a three-month period.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 results with those in the control group whose treatment did not include pharmacogenomic testing.
The results showed that patients who used the test service had 40% fewer emergency visits and 58% fewer hospitalizations of inpatients during the six months following the test. In addition, the costs of using health care decreased by $ 1,948 per patient over the same six-month period.6
Related content: How Virtual Reality Improves Care for Mental Disorders
Last thoughts
Siddhartha Mukherjee, Pulitzer Prize winner, said:
"In the 21st century … we are building a new epidemiology of the self: we begin to describe the disease, identity, affinity, temperament, preferences – and, ultimately, fate and choice – in terms of genes and genomes. The influence of genes on our lives and on our beings is richer, deeper and more annoying than we had imagined. "
As the integration of genetic testing into mental health care continues, we still have a lot to learn. Like any advanced science or disruptive technology, there has been a lively debate. But mental illness is a global crisis that shows no signs of slowing down. As health practitioners, the time has come for us to embrace innovation to improve our efforts to help patients.
Genetic testing offers a way forward to partner with our patients with a more personalized and accurate approach. To fully understand their situation, we must do everything possible to shorten the time they have to fully recover.
For more information on the pharmacogenomic test we use in our practice, visit www.genomind.com.
Author's Disclosure: "Genomind and Potomac Psychiatry Engage in Continuous Marketing Collaboration to Increase the Visibility of Genomind's Pharmacogenomic Services and Potomac Psychiatry Genetic Testing Consultations."
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References
- NIMH Report: Prevalence of Mental Illness (2017)
- Insel, T.R. (2008). Evaluate the economic costs of a serious mental illness. The American Journal of Psychiatry. 165 (6), 663-665
- https://www.cdc.gov/mentalhealth/learn/index.htm
- Fagerness J, E Fonseca, Hess GP, Scott R, Gardner KR, Koffler M, Fava M, Perlis R, Brennan FX, Lombard J Psychiatric intervention under pharmacogenetic control badociated with increased adherence and cost savings. 20 (5): e146-5
- Brennan FX, Gardner KR, Lombard J, Perlis, RH, Fava, M Harris, HW Harris, Scott R. Prim, Caregiver, Central Nervous System Disorder. April 16, 2015; 17 (2). doi: 10.4088 / PCC.14m01717
- Perlis R et al. Pharmacogenetic tests in patients with mood and anxiety disorders are badociated with lower use and cost: matched propensity score study. Depression and anxiety, 2018
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