“This test (GeneSight) saves money.”
I’m Dr. Allan Anderson. I’m a board certified geriatric psychiatrist. I practice predominantly in treating patients who are older so I do practice the trade of geriatric psychiatry. What is really revolutionary in the field of managing anxiety and depression is the availability of a test like GeneSight, a pharmacogenomic test that tells us if for this patient, this particular medicine may be the best choice.
Depression is common in geriatrics. You have two kinds of depression. We often see depression from people who have had lifelong depression, and so they’re experiencing recurrence for another episode of the depression. And then you have patients who have depression to come on in older age. Comorbidity is a tremendous issue in dealing with geriatric patients. Many of the patients who come to see me for treatment of depression, for example, are on multiple other medicines. Cardiac medicines, medicines for pulmonary disease, medicines for pain. Chronic osteoarthritis is a very common presentation with many of my patients. It’s uncommon for me to have any geriatric patient to come in not on any medication. And so this does complicate things a bit because you now have to think of medication and drug interactions. And this is where pharmacogenomic testing and my use of the GeneSight test has also been quite helpful, because there are drug-drug interactions that we need to be aware of. But as important, it’s essential for us to know if we’re putting someone on a medicine that may have some drug-drug interaction, that we know how that medicine is going to be handled by this individual patient. And I’ve had patients in my practice where when you treat things like depression and anxiety they may need fewer medicines for things like hypertension. They may do better in terms of other medical conditions like pulmonary conditions. And clearly there’s a link with people having depression and having more medical related visits, for example, to the ERs, to their doctors’ offices. And so by effectively treating depression, while we’re not going to treat hypertension totally we may help patients get off or get on reduced doses of some of the medicines they’re on, and I think that’s probably most prominent in patients with chronic pain.
Medicare approves this test. Why would Medicare approve a test? One, it has to be a useful test. It has to provide information that will help the patient. And two, it has to be cost-effective. If anything, these days the body that governs how Medicare spends its money, CMS, Center for Medicare and Medicaid Services, are very resistant to pay for anything unless there is data that shows that there’s an economic advantage, and Medicare’s looked at the same studies I’ve looked at and this test saves money. I think that the use of pharmacogenomic testing such as the GeneSight test is a great breakthrough in our field of selection of medications for patients. For the first time we have some real science there.