One of the issues in psychiatry today is the lack of personalization. Physicians have historically used a “one size fits all” approach to prescribing medications, even though we know that women and minorities do not process antidepressants the same way as white men.
At Prairie, we are tackling this issue by using genetic testing. While genetic testing cannot pick the perfect medication for patients, it helps physicians plan treatments, resulting in various benefits such as fewer side effects, lower costs, and faster recoveries for patients.
Here, we discuss how genetic testing works at Prairie and how it helps physicians prescribe medications.
How does genetic testing work?
We know that some enzymes, a type of protein, play a large role in drug metabolism. However, individuals may have different variations of these enzymes, which affects the way they process, or metabolize, drugs. These variations are common; over 90% of people have at least one variant that could impact their treatment.
Six enzymes account for approximately 90% of drug metabolism. As a result, it’s possible to understand how an individual processes medication just by understanding the variations in their enzymes. One way to do so is by using a patient’s genetics, which influences the enzymes they produce.
Single nucleotide polymorphisms (SNPs, pronounced “snips”) are the most common form of genetic variation. DNA is composed of four different building blocks; a SNP occurs when one building block is substituted for another. Generally, genetic variants are defined by SNPs in a person’s genes.
These differences in genes correspond to differences in the enzymes that a person produces. The variants are correlated to the speed at which a person metabolizes medication, which is particularly useful for understanding the appropriate dosage a person needs. This is helpful to physicians because many patients take antidepressants at inappropriate dosages, especially if their medication was prescribed by a primary care physician rather than a psychiatrist.
How do doctors use genetic testing?
Once physicians understand the variations in their patients’ enzymes, they are able to make more informed decisions about which medications and dosages to use. This isn’t to say that genetic testing can pick the perfect medication for doctors; however, the insights that genetic testing provides have been clinically proven to help patients.
For example, if a patient metabolizes an antidepressant slower than average due to variations in their genetics, then the antidepressant will stay in their body for longer. As a result, there is a higher chance that their medication will result in adverse side effects like nausea, weight gain, and fatigue. By knowing a patient’s metabolic profile, physicians can avoid prescribing too much of an antidepressant, allowing the patient to avoid adverse side effects.
To make these decisions, our psychiatrists only use recommendations that have been validated by groups such as the Clinical Pharmacogenetics Implementation Consortium (CPIC).
Conclusion
Remedying the “trial and error” approach to psychiatry has been an active field of research for decades. Genetic testing is one way forward; by identifying the genetic variants in their patients, doctors are able to make more informed treatment decisions. This results in real benefits for patients. For psychiatry in particular, patients see greater reductions in their symptoms, lower healthcare costs, and fewer side effects. This is especially true for patients who have found their previous antidepressants to be intolerable or ineffective.
These benefits speak for themselves. That’s why we provide genetic tests to every one of our members, who are shipped DNA kits after meeting with a Care Partner. After the member sends their spit sample to our accredited partner lab, our psychiatrists receive a report to help guide treatment.
Ultimately, our number one priority is our members and their mental health. We give our members every evidence-based opportunity to get better, which includes using genetic testing to provide personalized treatment. It’s just one more way we’re making mental healthcare more effective.
