Empowering Senior Patient Care with Pharmacogenomics: Insights from the GeneSight Engage Webinar

The most recent GeneSight Engage webinar explored how pharmacogenomic testing, particularly the GeneSight® test, is transforming the landscape of mental health treatment for adults aged 65 and older. The expert panel highlighted real-world insights and clinical best practices, speaking about how personalized medicine has the potential to reduce trial-and-error prescribing, minimize side effects, and lead to improved outcomes for this vulnerable population.

Starting out

Meet the panelists:

• Justin Weirich: A primary care doctor of osteopathic medicine, passionate about holistic, patient-centered care and the future of pharmacogenomics in medicine.
• Whitnee Brown: Dual board-certified family and psychiatric nurse practitioner, seasoned educator, and peer-reviewed author, with deep expertise in mental health.
• Casey Hilde: Clinical pharmacy leader and educator, with advanced training in pharmacogenomics and a focus on treating complex psychiatric illnesses and integrating pharmacists into collaborative care models.

The webinar was moderated by Dr. Morgan Freas, an executive medical science liaison with Myriad.

Dr. Freas asked each of the panelists how they learned about the GeneSight test.

Dr. Weirich was introduced to the GeneSight test when a patient specifically requested it. “A patient walked into my office specifically asking for GeneSight,” he shared. “She was a success story right out of the gate. It kind of spoke for itself.” Over time, he found the GeneSight test to be uniquely suited to his practice compared to other genetic tests.

Dr. Hilde first learned about pharmacogenomics in pharmacy school, then recognized its value during the COVID-19 pandemic when primary care providers managed more depression and anxiety cases due to psychiatrist shortages. The GeneSight test became an helpful “tool in the toolbox.”

Dr. Brown learned about the GeneSight test as a student. She saw firsthand how difficult it is for patients to find the right medication and how GeneSight could help provide explanations for some patients, improving rapport and patient confidence.

Understanding Depression in Older Adults

The panel discussed how depression in seniors presents differently.

Dr. Hilde noted that older adults, especially men, tend to present physical symptoms like chronic pain and cognitive difficulties, and older patients are often reluctant to verbalize emotional distress.

Dr. Brown added that many seniors isolate due to loss or fear of being a burden and that their depression may not look like typical sadness. She noted that asking direct questions is crucial since many patients won’t open up otherwise.

Medication Selection: A Complex Puzzle

Dr. Hilde shared in the webinar about some of the things he thinks about when treating the older population:

Dr. Hilde noted that it is important to get it right quickly. The Beers List and GeneSight testing are two things he uses to help avoid medications likely to cause harm and tailor treatments based on the patient’s genetics. He also explained how important it is to take into account liver and kidney function. Dr. Hilde further provided an example of how increased age combined with genetic variations can raise drug levels.

Dr. Brown described a case study of where she had used GeneSight testing for an 80-year-old woman with depression. She noted that the GeneSight test showed significant gene-drug interactions with many of her current and past medications. Using the insights gained from the testing along with taking into account other clinical factors for the patient, Dr. Brown and the patient decided to reduce her current medications and start desvenlafaxine. At follow-up, the patient was smiling, engaged in social activities, and her PHQ-9 dropped dramatically. “She told me it was the best that she had felt in years.”

Dr. Weirich noted that for him, “anytime I’m considering any pharmacotherapy, the conversation about GeneSight starts right away.” He also highlighted how seniors may have a shorter window for effective treatment and using the test can help build trust with the patient. Dr. Brown agreed, noting the importance of early conversations to close treatment gaps swiftly.

Discussing Cost and Access

The panelists emphasized transparency when discussing cost with patients. It was noted that for Medicaid and Medicare patients, GeneSight testing is [typically] $0 out-of-pocket. Others have a maximum $330 cost with financial assistance programs available, making it accessible to many.

Outcomes That Speak for Themselves

The panel closed by sharing the hopeful outcomes seen in their practices. Dr. Brown noted how for some of her patients, the GeneSight test has offered them hope and peace by helping them understand the “why.” Dr. Hilde called it, “a tool in the toolbox,” which may be able to help reduce suffering, improve quality of life, and improve rates of remission. Dr. Weirich concluded
with his experience where he noted cases in which use of the GeneSight test resulted in success in reaching remission, reductions in polypharmacy, reductions in side effects, and a strengthening patient relationships. He ended by saying to “let it speak for itself.”

Full webinar can be found here: