HomeGenetic InsightsSmoking status & the GeneSight test Smoking status & the GeneSight test September 19, 2023Genetic Insights In August 2023, Myriad Genetics enhanced the GeneSight Psychotropic test to include information on how a patient’s smoking status may impact their body’s metabolism of certain mental health medications. The GeneSight Psychotropic test will now provide non-smoking and smoking results when applicable. These updates were based on a comprehensive analysis of peer-reviewed literature and our continued commitment to provide clinicians and patients with genetic insights to help inform treatment decisions. The prevalence of smoking cigarettes in patients who have depression or anxiety is higher than in the general population.1 Daily or near-daily use of marijuana is two times higher in individuals with depression compared to those without it.2 What’s considered “smoking”? On the GeneSight report, smoking is defined as the daily inhalation of burning plant material, such as cigarettes and marijuana. The definition excludes vaping and e-cigarettes. How does smoking affect my GeneSight test results? In addition to genetics, environmental factors, such as smoking, can cause a gene-drug-environment interaction, which may affect how certain medications are broken down in the body. The CYP1A2 gene encodes for the CYP1A2 pharmacokinetic enzyme that is involved in the metabolism (or breakdown) of various medications, including certain antidepressants, anxiolytic and hypnotics, and antipsychotics. Some patients have a highly inducible genetic variant in the CYP1A2 gene, and this variant in the presence of smoking can result in increased CYP1A2 activity. This increase in CYP1A2 activity may result in faster than normal breakdown of certain mental health medications found on the GeneSight report. For these patients, the categorization and information provided on the GeneSight report for certain medications can be affected by smoking status. See this Genetic Insight for more information on rates of metabolism. What is the prevalence of the CYP1A2 variant? Data has shown that about 91% of patients have a CYP1A2 variant that is highly inducible by smoking. The presence of this variant in those who smoke may cause certain medications metabolized by CYP1A2 to be broken down more quickly than normal. For the roughly nine percent of patients who don’t have the CYP1A2 highly inducible variant, smoking is not expected to impact how quickly these medications are metabolized through CYP1A2. How many medications are potentially affected by smoking? Roughly a third of all medications on the GeneSight Psychotropic report are identified as having CYP1A2 involvement. These 23 medications include several antidepressants, anxiolytics and hypnotics, and antipsychotics. How does smoking status appear on the GeneSight report? The GeneSight report has been modified to include new labeling about smoking status near the top of the impacted medication pages for patients with the highly inducible CYP1A2 variant (91% of the population). For these patients, the GeneSight report will include non-smoker and smoker pages of results for antidepressants, anxiolytics and hypnotics, and antipsychotics. In addition, medications impacted by smoking status are labeled with clinical consideration number 7, which indicates that smoking status changes the results of the specific medication. Accordingly, clinicians are referred to use the section labeled “Smokers” if the patient smokes. Medications in two other classes on the report – mood stabilizers and stimulants and non-stimulants – will not have separate non-smoker and smoker pages, since CYP1A2 is not predicted to influence the breakdown of these medications. Patients who do not have the highly inducible CYP1A2 variant will not receive separate non-smoker and smoker results. For these patients, their reports will note that the test results provided are for both non-smokers and smokers since the patient does not have the highly inducible CYP1A2 variant. For more information on how to interpret GeneSight report, please read this Genetic Insight. How will my clinician use the test results? Your clinician may use the results of the GeneSight Psychotropic test to help inform medication selection and treatment decisions, based on your unique genetic makeup. Test results could be especially helpful for patients who have experienced side effects or have failed to respond to certain medications. For more information on the GeneSight test, email us at [email protected], or contact us at 855.891.9415. This document is for educational purposes related to pharmacogenomics and personalized medicine only and should not be considered medical advice. The information is based on scientific opinion from industry experts and is intended to provide additional information to healthcare providers. These materials may be changed, improved, or updated without notice. Myriad Genetics is not responsible for any errors or omissions contained in third-party content. We encourage you to contact us for specific scientific advice regarding our GeneSight® tests. You may print a copy of this document for your own personal noncommercial use. You may not copy any part of this document for any other purpose, and you may not modify any part of this document without the permission of Myriad Genetics. All rights reserved. 1 Cornelius, M.E. et al. (2022). “Tobacco Product Use Among Adults- United States, 2020.” MMWR Morb Mortal Wkly Rep, 71 2 Dai, H. and K.P. Richter. (2019). “A National Survey of Marijuana Use Among US Adults with Medical Conditions.” JAMA Network Open, 2(9):e1911936 Patient Common Antidepressant Side Effects Taking an antidepressant can be an effective way to help treat a mental health condition like depression or anxiety. However, these medications can also cre... Read more Patient MTHFR Mutations: Clinical Implications and Management Strategies MTHFR mutations—changes in the methylenetetrahydrofolate reductase (MTHFR) gene—have gained increased attention in the medical community due to their potent... Read more Patient Can an App Help Me Manage My Anxiety? Health and wellness smartphone apps have become so common that if you can name a health goal, desire or condition, you can probably find an app for it. N... 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Patient Common Antidepressant Side Effects Taking an antidepressant can be an effective way to help treat a mental health condition like depression or anxiety. However, these medications can also cre... Read more
Patient MTHFR Mutations: Clinical Implications and Management Strategies MTHFR mutations—changes in the methylenetetrahydrofolate reductase (MTHFR) gene—have gained increased attention in the medical community due to their potent... Read more
Patient Can an App Help Me Manage My Anxiety? Health and wellness smartphone apps have become so common that if you can name a health goal, desire or condition, you can probably find an app for it. N... Read more
Patient Black Trailblazers of Psychiatry and Mental Health: A Legacy of Healing and Advocacy As we celebrate Black History Month, we want to recognize a few individuals who have made extraordinary contributions to the field of psychiatry and mental heal... Read more
Patient Mindful Moments: Tips for Anxiety If a well-meaning friend or family member has ever told you to “just breathe” when you’re feeling worked up or stressed out, you’d be forgiven if you felt l... Read more
Patient Hints To Help You Have A Better New Year The holidays have ended, and a new year has begun—a time when many embrace a fresh start by setting New Year’s resolutions. This year, why not consider s... Read more
Patient Movement as Medicine: Solutions for Anxiety Moving forward. It sounds like a nice idea, especially when you’re feeling stuck deep in the throes of an anxiety spiral. But it turns out that physically m... Read more
Patient Weight-Loss Drugs and Mental Health: What You Need to Know New medications for weight loss seem to be flying off pharmacy shelves these days. But could they be linked to mental health conditions? Researchers are ... Read more
Patient 3 million patients (and counting!) have now taken the GeneSight test! We’re thrilled to share that 3 million patients (and counting!) have now taken the GeneSight test! We're so grateful to the dedicated healthcare providers who... Read more
Patient The Model Minority Myth and Mental Health The model minority myth stereotypes one cultural group, typically Asian Americans, as “intelligent, hard-working, and diligent and therefore more academically, ... Read more