Genetic Testing for Psychiatric Medications

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

Genetic Testing for Psychiatric Medications. Psychiatrists in Philadelphia, Pittsburgh, Manhattan, South Jersey & Delaware. Virtual and In-office.

As academically oriented psychiatrists and mental health providers with offices in Philadelphia, Pittsburgh, Manhattan, South Jersey, Delaware and Florida, we strive to practice evidence based medicine and the highest quality of psychiatric care that is available. That is why we have begun to offer genetic testing for patients, who are struggling with low mood, anxiety or other psychiatric difficulties.

Genetic testing for psychiatric medications may be indicated for individuals with treatment resistant illness (having failed multiple medication trials for depression or anxiety disorders), individuals who have difficulty tolerating psychiatric medications (for example, having multiple side effects from psychiatric medications), and in cases where additional information about a patient’s ability to metabolize psychiatric medications, prior to starting psychiatric treatment, may be helpful.

Psychiatrists and mental health providers use genetic testing to make educated decisions about what psychiatric medications to use and what type of dosing patients may require. For example, suppose that a patient suffers from times with low mood, as well as episodes of high stress and anxiety. This same patient is rather frustrated with their psychiatric care, as they have had trials of Prozac (Fluoxetine), Paxil (Paroxetine) and Effexor (Venlafaxine). After genetic testing at our Philadelphia office, it is found that this patient is a “Rapid Metabolizer” of medications that are broken down in the liver by the P450-2D6 enzyme. The patient and provider at Rittenhouse Psychiatric Associates discuss that this means that their body breaks down all of these medications quickly, and this may be resulting in the failure of these medications to adequately treat her mood and anxiety disorders. In this case, the patient was transitioned to Zoloft (Sertraline), which is primarily metabolized by the CYP450-2C19 enzyme, and her depression and anxiety resolved at a normal dose, without significant side effects from this medication.

Another instance where genetic testing may be clinically useful, is testing for MTHFR gene mutations among patients. The MTHFR gene produces an enzyme that is necessary for one to properly utilize Vitamin B9 (Folic Acid). Gene mutations can decrease one’s ability to transform Folic Acid into L-Methylfolate (its active form). Research indicates that as many individuals as half of the population have an MTHFR gene mutation. MTHFR mutations may increase susceptibility to multiple medical conditions (this is a budding area of research). Additionally, activated Folate goes on to create the very neurotransmitters that medications target in Major Depressive Disorder, Generalized Anxiety Disorder, Panic Attack Disorder and other psychiatric conditions (Serotonin, Norepinephrine and Dopamine).

In this case, a patient may have significant improvement with both Depression and Anxiety, by adding the supplement L-Methylfolate to their vitamins (as opposed to starting a psychiatric medication). This is only discovered however, after a genetic test at Rittenhouse Psychiatric Associates shows an MTHFR heterozygous gene mutation. We are able to test individuals for this genetic mutation, who are seen at our offices in Philadelphia, Pittsburgh, Manhattan, South Jersey, Delaware and Florida. We can also arrange for tests to be sent to individuals throughout PA, NJ, NY, DE and FL, if they are seen via Telehealth appointments.

Genetic testing for genes implicated in the treatment of mood disorders, anxiety disorders and other psychiatric difficulties is an exciting area of research and we would be happy to discuss further how we can utilize this cutting edge technology to best help you with your struggles.