I am a psychiatrist, a member of the National Network of Depression Centers (NNDC), and member the NNDC’s Electroconvulsive Therapy (ECT) Task Group.
I’m also part of a small group of board certified psychiatrists who also are certified for advanced clinical psychopharmacology — the study of effects of drugs on the mind and on behavior. This has long been an interest of mine because medications are such an important part of therapy.
I see patients who are suffering from depression, or are referred for other treatments — referred to as Neuromodulation Therapy — such as Electroconvulsive Therapy (ECT), repetitive Transcranial Magnetic Stimulation (rTMS) therapy, and left Vagal Nerve Stimulation (VNS) therapy. These patients often have struggled with mental health issues for some time and feel they are out of options.
Understanding and Educating Patients
When I first talk to patients, I want to try and determine why they are not getting better. I want to know about other medical issues they may be experiencing. I also want to know if they have had side effects from medications and if they’ve had genetic testing done.
In my training, I’ve really tried to understand the correlation between physical illnesses and mental illnesses, and to understand the role of multiple medications in treating those illnesses.
One of our roles as psychiatrists is to help educate our patients about the interactions between illnesses. I see a number of first-time patients who are overweight, may complain of being tired during the day, or have had trouble sleeping. For example, if they have had trouble sleeping, I may refer them to other specialist for a sleep study and to find out if they have sleep apnea. Once that is treated, we may see they experience relief from their symptoms of depression.
Early Interest in Genetic Testing
In medical school, I remember our instructors suggesting that when we first meet a patient, we ask about the family history and see what the patterns are when making a diagnosis or considering treatment options. But, family histories don’t tell the whole story. An individual’s genetic profile plays an important role, too.
I began following the correlation between genes and mental health as early as 2004 – and first became familiar with GeneSight in 2008. I am one of the first psychiatrists to use the test with my patients.
It’s eye opening when patients first learn about the option to do genetic testing. And, when you consider that $330 or less is the most many patients would pay, they recognize the value can be much higher. When you are desperate for answers, the cost is very reasonable.
The GeneSight Test Helps Light the Way
If a physician asked me about GeneSight, I would tell them that if you’re walking on a dark road, wouldn’t you want to have a light helping guide you to where you want to go? For me and others, pharmacogenomics is the missing link.
Patients with mental health needs struggle with trial and error prescribing. If medication is warranted for a patient, we need to be systematic about how we make medication decisions. For example, genetic testing may tell us that a patient is an ultra-rapid or slow metabolizer. With that information, we know why they may not have tolerated a medication very well and can prorate dosing, while looking at which medications are genetically most appropriate for the patient.
GeneSight is a GPS. You don’t want to rely on the test alone. The doctor needs to know and understand the patient. But once that happens, this test can be very useful.
In the near future, I hope that every physician will use genetic testing to help establish a baseline for a patient, just like a laboratory test. For me, that technology is here today.