Despite the fact that psychiatrists utilize psychiatric medications as a primary treatment tool, they have found that patients vary widely in their responses to the medications. All too often, TAU—treatment as usual—using medications—proved ineffective, leaving one more difficult to treat patient. These repeated treatment trials have a cost, too, not only to treat the patient’s psychiatric concern, but also a related cost with comorbid conditions.
“How many of you know of a patient who has failed in multiple trials of psychiatric medications?” asked Nancy Grden, general manager of Genomind, at the Open Minds Conference in Baltimore. To a show of hands, she stated, “Our job is to help psychiatrists do a better job of prescribing.”
Grden described a new saliva-based genetic assay, called the Genecept assay, that evaluates a subset of genotype information. With just a small sample of saliva, the assay identifies genetic biomarkers for neurotransmitter activity within the patient’s brain—a frequent target of psychiatric medications— as well as pharmacokinetic genes, which assess the body’s ability (speed, efficiency, receptivity) to metabolize various medications. These tests don’t predict disease, but rather, the ability of the brain and the body to respond appropriately to medication.
Assays are mailed to a processing lab, which performs the patent-pending assay. Results are sent to the psychiatrist, followed by a clinical consult call, in which a Genomind-trained physician reviews the results—and their possible implications—with the treating psychiatrist.
It’s all about creating “a new paradigm” for prescribers, especially for hard-to-treat patients. One common and important finding, said Grden, is that a patient will not respond well to SSRIs—selective serotonin reuptake inhibitors—one of the most common classes of antidepressant medications. With this knowledge, the psychiatrist can adapt to a different regimen of treatment—avoiding months of repeated and ineffective trials for the patient with different SSRI medications.
Grden also described the impact of the assay results on prescribers, who, as might be expected, employed the assay for difficult-to-treat patients. Citing results from 411 patients, Grden said that 86 percent of prescribers said that the assay results influenced their treatment decisions—a result that Genomind found surprising until, as Grden explained, they realized that psychiatrists have so few predictive tools available. Over 90 percent of prescribers said that the assay improved their confidence in prescribing decisions, while 75 percent said that they made treatment changes—typically changing medication doses, changing medication classes, augmenting treatment with a second medication, or adding a “medical food” or supplement that the assay predicted would be effective and well tolerated by the patient.