Genetic testing becoming critical for patients, clinicians

Information to help clinicians determine which medications or other treatment options for various mental health conditions are better suited for patients based on their genetics is continuing to gain traction in the field.

Genomind Professional PGx, Genomind’s flagship pharmacogenetic product, is designed to reduce the burden on the health care system and improve results for patients by cutting down on the “trial and error” of mental health medication selection, say officials at the King of Prussia, Pennsylvania-based mental health care company.

Officials announced May 20 that Genomind Professional PGx is now available to patients through their health care providers. The comprehensive pharmacogenetic test helps clinicians guide treatment. The test provides information on a patient’s personal genetic makeup, which can show what medications may be more likely to be effective, and which can result in additional side effects.

“Psychiatry is a very complicated field,” Violina Frenkel, M.D., psychiatrist at Integrative Behavioral Care and vice chair and chief of clinical psychiatry at Overlook Medical Center in Summit, NJ, told MHW. “We do not have a lot of measurement tools. We have our own experiences, our own judgement.”

Frenkel said she has been using genetic testing in her practice for about six or seven years. “You still have to use your clinical judgement,” she said. “Genetic testing can give you a good start.”

Frenkel added, “This testing will not tell you the medication to pick, but the results can significantly narrow down the list of medications that should work for the patient. The center of care should be doing everything you can to provide the proper medication to patients.”

The testing helps to counter stigma and some of the reactions consumers may have about psychiatrists, said Frenkel. “[They may say] ‘Psychiatrists don’t know what they’re doing. We’re guinea pigs; they’re just going to throw any medication at us,” Frenkel stated.

Remission Rates

“When you first put patients on medications, only 50 percent respond,” Frenkel said. There’s usually a 30 percent remission rate. When patients are switched medications to determine what works, their response rates go down. “If you switch two to three times, you might not get a response,” she said.

Frenkel pointed to certain developments related to medication and remission rates in patients. She pointed to the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study in 2006 by the National Institute of Mental Health. The study assessed the effectiveness of adequately delivered treatments in “real world” outpatients who have major depressive disorder (MDD) and included four levels of treatment. The STAR*D study was designed to assess the effectiveness of treatments for people with MDD who have not responded to initial treatment with an antidepressant (see MHW, Jan. 16, 2006; March 27, 2006).

‘Actionable Information’
The CEO of Genomind said clinicians are often telling officials that genetics is becoming an increasingly necessary component of their clinical evaluations. “It provides actionable information in the context of their clinical evaluation to help guide medication selection for 11 mental health conditions, including depression, anxiety, ADHD, bipolar and substance abuse,” Shawn Patrick O’Brien told MHW.

“We believe that psychiatry is undergoing an evolution into personalized medicine, which can involve tools and technologies like genetic testing, imaging etc.,” he said. “This requires time and effort to help translate cutting-edge sciences and new technologies into clinical practice.”

Testing involves the clinicians taking a painless cheek swab from patients to obtain two samples of the DNA to be tested in Genomind accredited labs, and if the requisition form is complete, results on the 24 genes and 130 medications are provided to the physician within 48 hours, said O’Brien.

Genetic testing is an essential component of a physician’s clinical evaluation, he said. “Each person’s reaction to medicine can be impacted by their genetic variations; the FDA has even provided genetic biomarkers on the labels of 200+ approved medications.” he explained. But the key here is that this information is to help guide clinicians – it is a tool in their arsenal to help inform medications/treatments.

The test does not compare pharmacologic therapy to other forms of therapy to other forms of therapy and is not a substitute for sound clinical judgment, O’Brien said.

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