How to Use GeneSight® Test Results
Given the variety of factors to consider in diagnosing and treating a patient’s mental illness, many providers find it helpful to use evidence-based resources and tools to reduce the number of variables.
For example, Oregon psychiatric mental health nurse practitioner Josh Sizemore finds the GeneSight® test, a pharmacogenomic test, particularly useful in helping to make treatment decisions.
“When you are looking at a complex patient picture, you want to limit the number of variables. Especially in the case of severe mental illness – you are trying to narrow down and pinpoint what’s really going on and what you need to do. You just don’t have a lot of time for errors. Families will stick with you for a while, but results matter. At the same time, conditions can be complex. For example, depression can be caused by 1,000 different things. My patient treatment philosophy is that we need to get to the root cause of depression, not just treat the diagnosis. I try to figure out the likeliest reason for depression: is it biological, genetic, conditional, or something else? The GeneSight test helps me reduce some of the variables in treatment decisions.”
What is the GeneSight test?
The GeneSight test analyzes clinically important variations in a patient’s DNA which may impact how they metabolize and/or respond to certain medications used to treat depression, anxiety, ADHD, and other psychiatric conditions.
Providers may use information from the GeneSight report – along with their experience, patient evaluation and professional judgement – to aid in medication selection and dosing. The results of the test show which medications may require dose adjustments, may be less likely to work, or may have an increased risk of side effects based on the patient’s genetic results.
Psychiatrist Caleb Whitenack, MD, says using the GeneSight test transformed his practice by helping to reduce the trial-and-error process.
“When treating with psychotropic medications, trial and error can disrupt the trust between patient and doctor. Severe side effects can cause harm – and as doctors we want to do no harm. For patients, after three or four failed trials, they can become demoralized that no medication can help get them back to the life they love,” he says.
How does the GeneSight test work?
The GeneSight test uses a cheek swab, which a healthcare provider may administer as part of a doctor’s visit along with a physical exam, health history or other tests.
Providers may choose to send a test directly to a patient through GeneSight at Home, which allows their patient to administer the swab themselves or with a family member’s help – no visit to your office required.
Understanding the GeneSight test
After the lab analyzes the patient’s sample, the provider receives a personalized report with medications coded into three separate categories:
- Green: Use as directed. These medications aren’t associated with any known genetic issues that would be expected to change the patient’s medication outcomes.
- Yellow: Moderate gene-drug interaction. These medications may require dose adjustments in order to have the desired effect, may be less likely to work, or may cause side effects.
- Red: Significant gene-drug interaction. These medications are likely to require dose adjustments in order to have the desired effect, may be less likely to work, or may cause side effects.
The report provides further details with the clinical considerations, which are denoted by numbers next to the medications. Many HCPs using the GeneSight test review the clinical considerations to better understand the rationale for a medication’s classification and to help inform treatment decisions.
Providers may use this data to help inform their patient’s medication decisions. It’s important to remember that even if a medication falls into the green category for a particular patient, it doesn’t mean it’s guaranteed to work and may not always be the best option. There are many other factors that influence medication response and susceptibility to side effects, including drug-drug interactions, diet, environmental factors, age and more.
However, many providers find the test results to be game-changing.
“The results of clinical studies on the GeneSight test speak for themselves particularly when you look at patients that have moved from red to green or yellow bin medications. I have seen it in my own practice. That’s why I lean heavily in using the GeneSight test earlier rather than later with a patient,” says Dr. Whitenack.
Enhancements to the GeneSight Psychotropic test
Based on a comprehensive analysis of peer-reviewed literature and our continued commitment to providing clinicians with genetic insights to help inform treatment decisions, the GeneSight Psychotropic report was updated to provide non-smoking and smoking results when applicable.
Many factors may influence medication outcomes in addition to genetics. Smoking is one of those factors as it can increase the activity of CYP1A2 – a gene involved in the metabolism of several mental health medications – in patients who have the highly inducible CYP1A2 variant.
For roughly 91% of patients with the CYP1A2 variant, the categorization and information provided for certain medications can be affected by smoking status.[i] Smoking on the GeneSight report is defined as the daily inhalation of burning plant material (such as cigarettes and marijuana). Vaping and e-cigarettes are not included.
Approximately a third of the medications on the report have CYP1A2 involvement, which means they have the potential to be categorized differently based on a patient’s smoking status. These 23 medications include several antidepressants, anxiolytics & hypnotics, and antipsychotics.
How the GeneSight test may help after the initial appointment
During a follow-up appointment, healthcare providers can discuss the report in detail with their patients. Many providers find that using this information in treatment discussions helps their patients feel more empowered in their mental health journey.
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[i] Frequency is based on internal Myriad Neuroscience data of more than 2.1 million tested patients.
Our articles are for informational purposes only and are reviewed by our Medical Information team, which includes PharmDs, MDs, and PhDs. Do not make any changes to your current medications or dosing without consulting your healthcare provider.
The GeneSight test must be ordered by and used only in consultation with a healthcare provider who can prescribe medications. As with all genetic tests, the GeneSight test results have limitations and do not constitute medical advice. The test results are designed to be just one part of a larger, complete patient assessment, which would include proper diagnosis and consideration of your medical history, other medications you may be taking, your family history, and other factors.
If you are a healthcare provider and interested in learning more about the GeneSight test, please call us at 855.891.9415. If you are a patient, please talk with your doctor to see if the GeneSight test may be helpful.