Rather than guessing, it’s worth it to find out

I am a dual certified adult medical and psychiatric mental health nurse practitioner with a diverse background in progressive care in cardiac and medical-surgical knowledge, as well as diverse experience treating various psychiatric conditions. I believe my role is to transform people’s lives, promote wellness, and advocate for self-care, self-love and self-compassion while teaching patients to actively participate in optimal health maintenance.

I have also been a full-time nursing educator and faculty member, and I have chaired a 250-student nursing program. I have taught didactic courses for pathophysiology, medical-surgical nursing, behavioral health, and pharmacology in nursing school. That study of pharmacology resulted in my learning about pharmacogenomics, which is what drew me to the GeneSight® test.

When I learned about the GeneSight test, I saw the need in those patients who may have had two or more medication or dose changes without any noted effective improvement of symptoms. That usually prompts me to order GeneSight to examine potential medication metabolism issues associated with genetic variation to help inform my clinical decision-making.

One of my most challenging patients was referred to me by their therapist. When I first saw their GeneSight report, of the six medications they were on, two were controlled substances with near maximum doses. The antidepressant was instructed to be taken on a “sliding scale.” Their GeneSight results showed they were a mixed metabolizer, both with rapid and slow pathways, intermediate response to SLC6A4 genotype, and also had the MTHFR gene mutation for reduced folic acid conversion.

I switched them to an SNRI, tapered down the SSRI, increased the mood stabilizer to create a counterbalance for the SNRI, tapered both controlled classifications of medications down to one, and got down to four medications total. L-Methylfolate was started to supplement the reduction of MTHFR enzyme. In the first week, there were subtle differences, and by the second and third weeks, major improvements. The patient reported they felt back to “normal”, which meant going to the gym, cooking, doing laundry, visiting the library or husband at work, which she stated she hadn’t been able to do the past three years. She is still doing well to this day, with mixed periods of depressive episodes and symptoms while processing emotions for complex trauma. The rewarding outcome is seeing her transform back to living life with moments of joy and hope.

All it takes is an electronic order to send a GeneSight kit to the patient to do at home and return. Results usually turnaround within a few days of receiving the test kit. It takes time to review, analyze, and explain the results to the patient, but it’s invaluable to know what we’re working with as providers when there is a suspicion of a genetically based medication metabolism problem. Rather than guessing, it’s worth it to find out. There is no substitute for giving our patients the best quality care.