Genetic Testing for Psychiatric Medications

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 psychiatric 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.

What is Included in a Psychiatric Genetic Testing Report?

A genetic testing report provides a clinical summary of your biological data. Most reports include the following information to help guide your treatment:

• Genes Tested: A list of the specific genes and genetic variants analyzed.
• Metabolizer Status: An assessment of how your body processes medications. This ranges from Poor (processing too slowly) to Ultrarapid (processing too quickly).
• Medication Grouping: A classification of various psychiatric medications based on potential interactions. Drugs are typically grouped into categories, such as minimal, moderate, or severe, to highlight which options may require dosage adjustments or carry a higher risk of side effects.
• Functional Insights: Information on how your genes might affect specific neurotransmitter receptors or transporters, which influences how a medication works in your brain.

Considerations and Limitations of Genetic Testing

Genetic testing is an informative tool, but it is one of several factors we can consider when developing your treatment plan.

• Non-Genetic Factors: A report does not account for variables such as age, weight, or lifestyle habits, all of which influence how you respond to treatment.
• Organ Function: Your current liver and kidney function play a primary role in how medications are cleared from your system, independent of your genetic profile.
• Drug Interactions: The test analyzes your DNA, but it does not account for interactions between different medications or supplements you may currently be taking.
• Clinical Guidelines: While pharmacogenetic testing is a valuable tool, it is not yet part of the standard clinical guidelines for all psychiatric conditions. Therefore, it may not be indicated for all patients.
• Integrated Care: We do not use these results in isolation. They are used alongside your clinical history and symptoms to develop a safe and effective medication management plan.

How Genetic Testing for Psychiatric Medications Can Improve 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!

[Set Appointment]

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 psychiatric 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.