Friday, October 19, 2018

Designer Genes


This is an excerpt from our original pos on BioPsychoSocial.
     If you take psychiatric medications, you’ve probably heard of pharmacogenomic testing. For the client who’s tried multiple medications and has yet to achieve significant symptom relief, it seems like a simple answer to a complex problem. Your provider swabs your cheek or draws a small sample of blood, sends it off to a lab, and within a few weeks, a list of medications expressly designed for your unique DNA appears, resulting in less trial and error and faster symptom resolution—at least that’s what the marketing people would like us to believe.
  
     A 2017 Journal of Clinical Psychiatry study put these claims to the test. Researchers from the University of Toronto performed a systematic review of 66 published research reports on pharmacogenetic testing to determine if there was reliable data supporting claims that testing resulted in better clinical outcomes for clients with Major Depressive Disorder. Five studies reported symptom improvement, but all had significant research biases. Most were not randomized, meaning study participants knew the purpose of the study and opted to participate. Several had study authors and industry funding that presented conflicts of interest; in other words, the people leading the study stood to benefit if results skewed in favor of genetic testing. Others lacked a control group, or had results that were not statistically significant.  Ultimately, the study authors concluded that more formal research is needed to determine whether or not testing moves the dial in symptom improvement.


Though a medication may be identified as favorable on a test readout, other factors such as side effects, interactions with other medications, and allergies may also rule it out.

     So does this mean that pharmacogenetic testing is psychiatry’s own version of Windows 8?—pricy, seductive, but ultimately unable to deliver on its promise?   Not necessarily, but in order to be useful, it’s important to understand what these tests reveal and their limitations. Pharmacogenetic tests uncover genetic variants that affect the way an individual’s liver enzymes process medications, also known as pharmacokinetics. While this information is helpful, pharmacokinetics alone do not provide enough information to ensure treatment success for any medication.  Furthermore, pharmacogenetic tests don’t measure actual liver function, which is crucial in determining how medications are processed and is affected by day to day habits such as alcohol intake, diseases such as hepatitis, or use and misuse of other medications. In addition, genetic tests don’t measure pharmacodynamics—or how the medication impacts the individual. Though a medication may be identified as favorable on a test readout, other factors such as side effects, interactions with other medications, and allergies may also rule it out.

Since the onset of genetic testing, consumers have been concerned that their results could be used to deny them employment or health insurance. In 2008, Congress filed the Genetic Information Nondiscrimination Act (GINA) to prevent this kind of discrimination. For more information on genetic testing and its impact, click on genome.gov.
Read the full post on our blog.

For the best psychiatrist near me, be sure to learn about a leader Austin Mental Health. We are a psychiatrist in Austin.



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