This week, I did a mental health assessment alongside a psychiatrist as part of our longitudinal mental health curriculum in residency.
Our patient was a young woman with generalized anxiety. She was referred to the psychiatrist because she had tried a few different medications, but they all seemed to cause side effects without providing much benefit.
This isn’t uncommon; many people need to try three or more anti-depressants before they land on what works for them.
For this particular patient, she was loath to try yet another anti-depressant. She was already doing the right things: she had quit vaping, drinking, and using recreational drugs. She was going to a counsellor every other week. And she regularly practiced mindfulness.
Despite adhering to these healthy habits, she was still experiencing distressing symptoms. So, the psychiatrist suggested something I hadn’t considered – pharmacogenetic testing.
Pharmacogenetic testing involves assessing someone’s DNA to see how they might respond to medications. This field has been around for a while, but I wouldn’t say it’s mainstream yet.
In order to provide my patient with the right information, I went home and did some research into the world of pharmacogenetic testing for mental health concerns. I came across this helpful paper all about testing options relevant to psychiatry in Canada.
Using the information the paper provided, I emailed my patient the three decent options below for getting this testing done in Canada. These options included the minimum recommended genes that are useful in psychiatry, cost less than $500 (some can get close to the $2000 mark), and are analyzed in a sufficiently-accredited laboratory.
Reasonable options for psychiatry-related pharmacogenetic testing in Canada:
- Genecept Assay (Dynacare) $495 CA
- RightMed Pharmacogenetic Test (OneOme, LLC) US $349
- TreatGxPlus (GenXys Health Care Systems) $499 CA
I wouldn’t routinely recommend this testing to my patients with mental health problems. It’s not currently covered by OHIP or most private insurance companies, and it doesn’t have robust evidence of efficacy. That said, it seems like a fair option for people who could benefit from medication, but who are hesitant to try (another) one.
One important caveat: medications are only one aspect of treating mental health conditions. CBT is a first-line treatment for anxiety and depression. This type of therapy over 8-10 sessions is a key treatment for mood disorders.
The psychiatrist also highly recommended two adjunctive treatments:
1. Mindfulness meditation at a dose of 5-minutes, 3 times a day
2. Daily exercise (she didn’t specify the dose, but for someone who is currently sedentary, I recommend a brisk walk or using a stationary bike for 15 minutes daily if possible.)
Furthermore, it’s absolutely essential to talk to patients with mental health concerns about their substance use. It’s like trying to treat someone’s asthma with a puffer without addressing their cigarette smoking. Our patient had identified on her own that tobacco, alcohol and cannabis were contributing to her anxiety, but many people need to be informed of the detriment of drugs and alcohol on mental health.
Have you come across pharmacogenetic testing? Let me know in the comments!
Stay well friends,
Dr. Kuhnow
Fascinating! I learned a little about this & nutrigenomics in undergrad, but hadn't yet heard of it being used in clinical practice.