Psychiatrist Genetic Testing & Medication Management

Dr. Pagnani: Medical Director and Founder of Rittenhouse Psychiatric Associates

If you are struggling with low mood, anxiety, or other psychiatric difficulties, trial-and-error medication management can be frustrating. While general prescribing guidelines are effective for many patients, they do not always account for individual metabolic differences. To provide more precise care, our psychiatrists and psychiatric nurse practitioners can utilize genetic testing (pharmacogenomics) to practice Personalized Medicine. This allows us to limit or avoid medications that your body cannot metabolize effectively and focus on options that align with your unique biological profile.

What is Psychiatric Genetic Testing?

Genetic testing for mental health uses a non-invasive sample to analyze how your specific genes affect your body’s metabolism of psychiatric medications. This information may also suggest response or likelihood of side effects (although more research is needed in this area).

While many providers prescribe based on general guidelines, a psychiatrist using genetic testing can look at your unique metabolic profile. This data helps us make educated decisions about which medications your body can metabolize effectively and can also give insight regarding dosing strategies.

Who is Psychiatric Genetic Testing for?

Genetic testing is not always necessary for every patient, but it may be indicated for::

• Treatment-Resistant Individuals: Patients who have failed multiple medication trials for depression or anxiety disorders.
• High Sensitivity: Individuals who have difficulty tolerating psychiatric medications or experience severe side effects.
• Pre-Treatment Analysis: Patients who want additional information about their metabolism before starting a new psychiatric treatment plan.

How Genes Affect Anxiety & Depression Treatment

Our providers use genetic insights to solve complex medication puzzles. Below are two common examples of how we can use this data in our offices.

1. The “Rapid Metabolizer” (CYP450 Enzyme)

• The Problem: A patient suffers from low mood and high anxiety. They are frustrated because they have tried standard medications like Prozac (Fluoxetine), Paxil (Paroxetine), and Effexor (Venlafaxine) with no success.
• The Genetic Insight: Testing reveals the patient is a “Rapid Metabolizer” at the P450-2D6 enzyme. This means their liver breaks down these specific medications too quickly for them to work.
• The Solution: Our psychiatrists transition the patient to Zoloft (Sertraline), which is metabolized by a different enzyme (CYP450-2C19).
• The Result: The depression and anxiety may resolve at a normal dose without significant side effects.

2. The MTHFR Gene Mutation

• The Problem: The MTHFR gene produces an enzyme necessary to utilize Vitamin B9 (Folic Acid). Up to half the population may have a mutation here, decreasing their ability to transform Folic Acid into L-Methylfolate (the active form required to create Serotonin, Norepinephrine, and Dopamine).
• The Genetic Insight: A test confirms an MTHFR heterozygous gene mutation.
• The Solution: Instead of adding a psychiatric medication, or increasing an already high doses, we may simply add the supplement L-Methylfolate to the patient’s regimen.
• The Result: Significant improvement in depression and anxiety by addressing the root biological deficiency, may be noted.

Our Process for Genetic Testing for Mental Health Medications

We aim to make this cutting-edge technology accessible to our patients across PA, NJ, NY, DE, FL, and the areas that we serve..

• Virtual and In-office Consultation: You will meet with a provider (Virtual or In-Office) to discuss your history and determine if testing is indicated.
• Sample Collection: We perform the test in our office or arrange for a kit to be sent directly to you for Telehealth appointments.
• Review & Plan: Once the lab results are in, we review the findings with you and adjust your medication plan according to your genetic profile, if indicated.

Schedule an Appointment for Genetic Testing

At Rittenhouse Psychiatric Associates, we believe in practicing evidence-based medicine. We provide quality psychiatric care to patients throughout PA, NJ, DE, NY, FL and others. We additionally offer in-office appointments in Philadelphia, Pittsburgh, Wilmington, DE and more.

We are currently accepting new patients for psychiatric evaluations and genetic testing. Schedule an appointment today!

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FAQs About Psychiatric Genetic Testing

How reliable and lasting are pharmacogenetic (genetic testing) results?

Your results are based on your DNA, which does not change, meaning your results are valid for your entire lifetime. CLIA-certified labs ensure high accuracy in analyzing your DNA to provide insights to what medications your body metabolizes properly.

Who can order genetic testing, and how is the process conducted?

Testing must be ordered by a licensed medical provider (MD, DO, NP) during a consultation. The process is non-invasive and painless, requiring only a simple cheek swab done in our office or via a kit sent to your home.

Is there a genetic test for mental disorders?

No, genetic testing cannot diagnose conditions like Depression, Bipolar Disorder, or Anxiety; diagnosis requires a clinical evaluation. The test is strictly a tool to guide medication selection after a diagnosis has been made.

How much is genetic testing for psychiatric medications?

Costs for genetic testing vary by lab. Commercial insurance plans often cover the cost if you have a diagnosis of Major Depressive Disorder and have failed at least one medication. Patients would additionally pay the practice initial consultation fee, which is listed on our fees-and-policies page.