By Kayt Sukel
Psychiatrists are pressed for time—there’s no doubt about it. In Medscape’s 2012 Psychiatry Compensation Report, more than one-third of respondents reported 25- 49 patient visits per week. And a whopping 10 percent reported they see more than 100 patients per week. That’s a lot of charts to keep up with!
And how long does the average psychiatrist have with each patient? By all accounts, not that much. Nearly one-half of survey respondents reported they have about 25 minutes with each patient. But 16 percent of respondents suggested they are spending less than 16 minutes per patient visit.
Taken together, that adds up to a lot of patients, and very little time. So how can a psychiatrist make sure they are getting the information they need in that condensed 20-minute window? How can they streamline the process to come up with the right treatment for each patient—without sacrificing quality of care?
Using Pharmacogenomic Testing to Refine Treatment
When it comes to psychiatric treatment, historically, finding the right drug has been somewhat of a trial-and-error process, based on a personal history and a close look at the side effect profiles. And that’s where pharmacogenomic testing shows real promise, by offering psychiatrists an extra piece of critical data that may help streamline treatment decisions.
Anil Malhotra, director of Psychiatry Research at Zucker Hillside Hospital , says pharmacogenomic testing like Assurex Health’s GeneSight Psychotropic test can help psychiatrists work out a patient’s treatment—both in terms of selecting the right medication and the right dosing strategy. It’s something that can be added to the medical history each patient provides as the doctor considers different therapeutic options.
“These tests can help us learn whether a patient is a slower or poor metabolizer. If their body is not chewing up the drug as fast as it needs to, they’ll get more side effects. So if you know they are a slower metabolizer, you can lower the dosage and still be pretty confident that they are getting enough for therapeutic value,” he says. “High metabolizers, on the other hand, may not respond to medication even at pretty high doses. But before you raise that dosage even higher, you want to be able to confirm their metabolism with testing beforehand.”
But Malhotra cautions that no drug, either in the antipsychotic or antidepressant category, shows any greater efficacy than others in clinical trials.
“If that patient has been depressed before, it helps to know if they’ve taken a medication—and if it worked. If they had something that worked in the past, it’s obviously likely to work again in the future. And even if family members have been depressed, someone who is genetically related to the patient, if they had a medication that worked for them, it’s worth considering that drug as a possibility,” he says. “Then you need to think about side effects. Each antidepressant drug has a slightly different side effect profile. So if your patient is overweight, a drug that results in weight gain may not be a good candidate.”
Having this kind of genetic information upfront, Malhotra says, can help clinicians determine whether to start a treatment regimen more or less aggressively. And that can save time in the long run. “This kind of information can help us get better outcomes, save money, and save time here in the hospital for both us and the patient,” he says. “So I’d tell clinicians that it’s important to keep these tests in mind, especially with patients who have a lot of side effects or don’t respond to what are commonly considered therapeutic doses of medication.”