What Is GeneSight Testing? How Pharmacogenomic Testing May Inform Psychiatric Medication Decisions
Finding the right psychiatric medication can sometimes involve trial and adjustment. People may respond differently to the same medication, and factors such as age, medical conditions, other medications, lifestyle, and genetics can influence treatment response.
Pharmacogenomic testing is one tool clinicians may consider when making medication decisions. GeneSight® Psychotropic is a pharmacogenomic test that analyzes certain genetic variations that may influence how a person metabolizes or responds to some medications commonly used in psychiatric care.
What Is Pharmacogenomic Testing?
Pharmacogenomics looks at how variations in a person's genes may affect their response to medications.
For some medications, genetic differences can affect how quickly or slowly the body processes a drug. This may influence medication exposure, dosing considerations, or the likelihood of certain adverse effects. The FDA recognizes a number of gene-drug associations that may be relevant when making therapeutic or dosing decisions.
GeneSight Psychotropic evaluates multiple genetic variations and provides information about potential gene-drug interactions for a range of psychiatric medications.
What Information Does GeneSight Provide?
The GeneSight report organizes medications according to whether the patient's tested genetic variations are expected to create a meaningful gene-drug interaction.
Depending on the medication and genetic findings, the report may provide information suggesting that a medication:
can be used according to standard prescribing guidance from a genetic standpoint;
may have a moderate gene-drug interaction requiring additional consideration; or
may have a significant gene-drug interaction that warrants greater clinical consideration.
The report may also provide clinical considerations related to medication metabolism or potential dosing implications.
Does GeneSight Tell You Which Medication Will Work Best?
No.
This is one of the most important things to understand about pharmacogenomic testing.
A medication appearing in GeneSight's more favorable category does not mean that the medication is guaranteed to work. Likewise, a medication with an identified gene-drug interaction is not automatically inappropriate for a particular patient.
GeneSight itself states that its testing identifies potential genetically related medication considerations but does not identify which medication will definitely work. The test also does not diagnose psychiatric disorders.
Genetics is only one part of medication decision-making.
Why Isn't Genetics the Whole Story?
Medication response can be influenced by many factors beyond the genes included in a pharmacogenomic panel.
A clinician still needs to consider the individual's diagnosis, symptoms, previous medication trials, response to previous medications, side effects, medical conditions, other prescriptions and supplements, age, lifestyle factors, and personal treatment preferences.
The FDA similarly describes pharmacogenetic information as information that may be used along with other information about the patient and the condition being treated when considering medication therapy.
For this reason, GeneSight should be viewed as an additional clinical tool rather than a replacement for a comprehensive psychiatric evaluation.
Who Might Consider GeneSight Testing?
Pharmacogenomic testing isn't necessarily needed for every person receiving psychiatric medication.
A clinician might consider whether additional pharmacogenomic information could be useful when treatment decisions are particularly complex—for example, when reviewing previous medication experiences, tolerability concerns, or options for future treatment.
Whether testing is appropriate should be determined individually between the patient and prescribing clinician. GeneSight notes that there are not clear clinical guidelines identifying one specific group of psychiatric patients for whom testing is universally indicated.
How Is the GeneSight Test Performed?
GeneSight testing uses a DNA sample collected with a cheek swab. The sample can be collected by a participating practice or through a home-collection kit ordered by the clinician. The sample is then sent to the laboratory for analysis, and the resulting report is made available to the ordering clinician.
The test must be ordered by an authorized healthcare provider, including appropriately qualified nurse practitioners.
What Happens After the Results Are Available?
The most important part of testing is not simply receiving a color-coded report.
The results should be interpreted in the context of the patient's complete clinical picture. A prescribing clinician can review the identified gene-drug interactions, current and previous medications, medical history, symptoms, treatment goals, and other relevant factors before determining whether any treatment change is appropriate.
Patients should not stop, start, or change the dose of a psychiatric medication solely because of a pharmacogenomic test result without discussing it with their prescribing clinician.
GeneSight Testing at Thrivewell Health
At Thrivewell Health, treatment decisions are individualized and made collaboratively.
When clinically appropriate, GeneSight® pharmacogenomic testing may be considered as an additional source of information during psychiatric treatment. Test results are interpreted alongside your symptoms, history, previous medication experiences, current medications, medical considerations, and treatment goals.
Interested in learning whether pharmacogenomic testing may be appropriate for your care?
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This article is for educational purposes only and does not constitute individualized medical advice, diagnosis, or treatment. Pharmacogenomic test results should be interpreted by a qualified healthcare professional in the context of the individual's complete clinical history.
Lisa Johnson, PMHNP-BC, MPH
Thrivewell Health