Groundbreaking Gene Testing in Psychiatry

The practice of psychiatry is about to undergo a major transformation. It has not been heralded much in the press and is only gradually affecting many psychiatrists. Still, it has profound implications for how psychiatrists will treat their patients in the coming years and decades.
Gene testing used to be out of the reach for most doctors and patients. It was too expensive and was very limited. Now a whole host of genes can be tested, usually at no cost to the patient. That testing will improve the ability to choose medications both for effectiveness but also for their side effect profiles.
Many of the drugs that are commonly used in psychiatry to treat both depression and psychosis are differentially metabolized in the liver. That is to say there are certain enzymes in the liver that breakdown many of the drugs used in psychiatry. Genetic mutations, however, can cause either excess or insufficient amount of enzymes to do the job. Thus, when the metabolism is speeded up many of these medications lose their effectiveness. When the metabolism is slowed down, however, the patient is more likely to suffer side effects that are toxic and potentially even fatal. Genetic testing now makes it possible to choose the proper medication based on how it will be broken down by that individual’s liver. Guided by genetic testing, a physician’s choice of medications can be more scientific and appropriate to the patient.
For example, the Cytochrome P450 liver enzymes 2D6 and 2C19 and 1A2 are all produced by genes that may make too much or too little of the enzyme. The different enzymes are very important in the breakdown of not only psychiatric medicines but many of the other medicines used to treat pain, breast cancer, embolism and stroke. By genetically testing for the variations in these genes many of the problems of modern medicine can be avoided.
The gene test is easily accomplished. Two Q-tips are used to take samples from the right and then the left cheeks of the patient’s mouth. The sampling is accomplished by the patient him or herself and there’s no discomfort or pain involved in the process. The psychiatrist sends off the samples by FedEx to be tested. The results are generally available in less than a week by computer. Thus, an informed choice of medication can be made by the time of the next visit to the doctor.
The previous revolution of psychiatry occurred when the theory that life events determined moods and behaviors gave way to trial and error methods of medication utilization based on the ideas of chemical imbalances in the brain. Freudian psychoanalysis gradually gave way to modern psychopharmacotherapy. Now psycho-pharmacotherapy is being modernized by the exponentially greater knowledge obtained from pharmacologic gene testing.
Dr. William Hankin, MD is Board Certified in General Psychiatry and is a Fellow of the American Psychiatric Association. For more information about this or other issues, contact Dr. Hankin at his Atlantic County office in Linwood 609-653-1400 or his Cape May County office in Cape May Court House at 609-465-4424. Or visit www.WHHMD.com for information about the practice.