GeneSight

[RxPsych]

---

Members do not see this ad.

Anyone have any knowledge of GeneSight and whether the information they provide is clinically meaningful? I'm leaning towards pessimism on this one, but I admittedly don't know anything about it.

 

[R. Matey]

I've mostly seen the reports in relation to what medication to prescribe. Some patients, PCPs, and Psych NPs seem to like it as a touchpoint when med trials fail. From what I've seen, the psychiatric genetics literature does not support strong conclusions about genetics guiding treatment because they explain very little variance individually hence why there's been increased interested in GWAS studies using polygenic risk scores though these have yet to achieve satisfying evidence for use in clinical prediction.

 

[PsyDr]

There is one RCT that says it is useful. However, the outcome measures are kinda silly (i.e., reduced genetic interactions). Then the APA (psychiatry) Taskforce said it is not useful, but that was chaired by Nemeroff who left Emory in disgrace after some ghost articles were signed by him. And the FDA shut down one of those pharmacogenetics firms.

... it costs $1500, maybe it kinda works for some people, but not others. For people who think $1500 is not a lot, it may work. However, if a car salesman charged you a premium to discover your perfect car, and it turns out to be a 10 year old Camry... you're gonna get pissed off. The same probably applies to people who spend $1500 only to get prescribed generic zoloft.

 

[tr]

It's a pharmacometabolism panel. Tells you whether the patient is a slow, fast, or normal metabolizer for each agent.

Helpful for patients who are either nonresponders (may be fast metabolizers who need above standard doses) or highly sensitive to side effects (may be slow metabolizers who need ultralow doses). I order one maybe a couple of times a year. I don't think they're worth doing up front on everyone because most patients respond to the first or second agent we try anyway. Only for patients who don't tolerate/don't respond to the first few meds tried.

It doesn't cost $1500, it's $350 if you have to pay out of pocket. Most insurances will cover if you can demonstrate 3 failed trials.

I prefer Genomind to Genesight because the results format is less misleading. Genesight is structured to pretend that it will tell you about agent-specific efficacy. It doesn't do that. It mainly just tells you about rate of elimination for each agent, which helps you decide on an appropriate dosing range. Plus a few marginally useful extras like MTHFR polymorphism info.

The Genomind results format is more straightforward about that fact. Genesight presents their report as if "normally metabolized" meant "efficacious" when those things are essentially unrelated.

 

[Therapist4Chnge]

It’s interesting to see where this tech has gone in the past 10-12 years. I remember attending a conference ~15 yrs ago on pharmacogenomics and testing was thought to be the next step in prescribing.

 

[R. Matey]

I'm curious: How predictive are genetics actually in determining metabolic rates for psychiatric drugs and are there any known moderators?

 

[medium rare]

I'm curious: How predictive are genetics actually in determining metabolic rates for psychiatric drugs and are there any known moderators?

Read about the cytochrome P450 system which regulates enzymatic metabolism and the direct effect on medication metabolism. This basically explains what the genomic tests measure.

Like @tr mentioned, it’s useful for non and partial responders and patients who’ve been on multiple past meds with poor response or tolerability. They can be helpful in medication selection and anticipating if a lower or higher dose will be needed. Beyond that, there’s limited utility. Insurance generally covers it. Out-of-pocket costs have come down considerably.

Also prefer Genomind over Genesight.

 

[futureapppsy2]

Helpful for patients who are either nonresponders (may be fast metabolizers who need above standard doses) or highly sensitive to side effects (may be slow metabolizers who need ultralow doses)

As an aside, I've often wondered if my mom is a pan-slow metabolizer of medication in general--she halves the dose of pretty much any med that she safely can, even OTCs, and seemingly does okay on them whereas regular doses of most things leave her miserable.

 

[futureapppsy2]

It’s interesting to see where this tech has gone in the past 10-12 years. I remember attending a conference ~15 yrs ago on pharmacogenomics and testing was thought to be the next step in prescribing.

I feel like the more we learn about genetics, the more we realize how little we understand genetics on a practically meaningful level, tbh.