Genetic testing for the best meds for you!

[Postictal]

I saw my psychiatrist yesterday. I have been on tons of meds, and I'm still depressed. This time, he brought up something new - genetic testing. I was like, huh? For what? I thought I knew about all the options out there. But there is something that just came on the scene...

First of all, he wants to do the MTHFR genetic test. My understanding is that people with a specific genetic marker are likely to have problems metabolizing folic acid properly into L-Methylfolate. Your blood levels of folic acid may be normal, but some people cannot properly break down the folic acid into L-Methylfolate, which is a form that can pass the blood brain barrier. If your brain doesn't get the L-Methylfolate, it can cause treatment resistant depression. And this can be treated with a "medical food" (basically like a vitamin, but a prescription is required) which is pure L-Methylfolate. 

ALSO there is another test he ordered, and this one BLEW MY MIND. It's a genetic test that will tell which antidepressants and antipsychotics are most likely to work for you, which ones should be avoided or watched very closely because you're likely to have side effects, or ones that you're likely to have a higher or lower serum level of, so you should be on a lower or higher dose, if you have a possible gene-drug interaction with that med, etc. 

The company that does this is called GeneSight. It's in the USA - have no idea about the UK or other places. The booklet they gave me says:

"Multiple clinical studies show that when doctors use GeneSight to guide their treatment, patients are twice as likely to get on the right medication. Plus, with treatment guided by GeneSight, patients saw a 70% greater improvement in their symptoms versus usual treatment."

I am on Medicare and medicare covers it 100% - which amazed the hell out of me. It must be useful if medicare will pay for it - they would only pay for it if it was proven to work and ended up saving them money in the long run.

The "test" doesn't even need blood - you just rub a cotton swab up against the inside of both cheeks. Easy peasy.

I haven't gotten my results yet, but I was amazed about this new option, so I figured I'd let people know that it's out there. You'd have to find a doc that has the test kits and such...I don't know, maybe if you contact the GeneSight company, they could tell you if any local providers participate in this.

I'll let you guys know when I get the results!

 

EDIT: Got my results! Result pics are in comments.

Edited June 17, 2015 by Postictal

[Hopelessly Broken]

Good luck. Sure wish I could have it done considering I have tried so many damned meds and had no response whatsoever. 

Anyways, hope the results are what you are looking for. 

[Flash]

My pdoc suggested that while I was titrating up on Doxepin. Fortunately that worked so I didn't need it. If I have to go off that for any reason, I'll probably try the test.

Edited June 11, 2015 by Flash

[cosima]

i wonder if this is available in canada. this is a really cool idea.

[Velvet Elvis]

Unless you've already tried a lot of meds with no luck, this is most likely total horseshit and/or someone trying to bill your insurance for needless tests.  The folic acid thing is legit but is going to show negative results for the vast majority of people with mental health problems.  

The second test just sounds silly.  That kind of test is the holey grail clinicians have been looking for for decades, and there's never been any indication that they have found it.  At best you're going to be charged for an extremely experimental test.

 

[Postictal]

Actually.. It has been proven to be quite useful in clinical trials... So much so that Medicare covers 100% of the cost. It's not a list of "take these medications", it's meant to guide treatment by giving you a list of medications that are more likely to work for you. And in that regard, it has been proven to work in multiple trials. That is why medicare covers it...it saves them money in the long run because you are much more likely to find the right medication more quickly by using the results as a guide rather than trying meds at random. 

And yes, I have tried a lot of medications. Literally dozens. The doctor who suggested it to me is not trying to make money. I've seen him for 6yrs and he works at the nonprofit mental health center. Sooo... 

Edited June 11, 2015 by Postictal

[melissaw72]

Postictal ... thanks for the post ... I emailed my pdoc about this (I see him today also) to see if he knows anything about it.

[Hopelessly Broken]

Hate to be negative but such is me. 

What if you get the results of the second test about medications that would be better for you regarding your genes and they are all ones you have already tried and they didn't work? Or they are ones that are unsuitable because of comorbid mental illnesses? 

[Indigo 'n dye]

 Prediction of response is estimated based on the documentation of variations in “target genes” that code for receptors and transporters that influence the response of the patient to a particular medication.

Prediction is the key word.

Psychiatric pharmacogenomic testing in clinical practice

[melissaw72]

I just did this test in pdocs office today.  He said results should be in by next week.

[Flash]

Hate to be negative but such is me. 

What if you get the results of the second test about medications that would be better for you regarding your genes and they are all ones you have already tried and they didn't work? Or they are ones that are unsuitable because of comorbid mental illnesses? 

That would suck. I don't know how good the results are, but My pdoc said there are about 40 medications on the list they test for. That's Quite a few so I imagine there would be at least some drugs popping up that you haven't tried. I believe the test costs three or four thousand dollars and my pdoc seemed to think that insurance would only cover part of it. So that might be an impediment right there. 

[Hopelessly Broken]

Well I've tried quite the many so I'd be too worried that would happen. If I could get it. They do those tests here but they aren't covered by insurance. 

[Flash]

Yeah, I see your signature now. You've probably tried most of what they test for.

Edited June 11, 2015 by Flash

[Hopelessly Broken]

Sigh.

[melissaw72]

Hate to be negative but such is me. 

What if you get the results of the second test about medications that would be better for you regarding your genes and they are all ones you have already tried and they didn't work? Or they are ones that are unsuitable because of comorbid mental illnesses? 

That would suck. I don't know how good the results are, but My pdoc said there are about 40 medications on the list they test for. That's Quite a few so I imagine there would be at least some drugs popping up that you haven't tried. I believe the test costs three or four thousand dollars and my pdoc seemed to think that insurance would only cover part of it. So that might be an impediment right there. 

​If you have medicare or medicaid insurance covers it in full.  Private insurance is a few hundred $, but there is financial assistance, according to the paper my pdoc gave me.

[Velvet Elvis]

Hate to be negative but such is me. 

What if you get the results of the second test about medications that would be better for you regarding your genes and they are all ones you have already tried and they didn't work? Or they are ones that are unsuitable because of comorbid mental illnesses? 

That would suck. I don't know how good the results are, but My pdoc said there are about 40 medications on the list they test for. That's Quite a few so I imagine there would be at least some drugs popping up that you haven't tried. I believe the test costs three or four thousand dollars and my pdoc seemed to think that insurance would only cover part of it. So that might be an impediment right there. 

​Whoever interpenetrates the results is still reading tea leaves.  The science here is nowhere close to cut and dried.  If the understanding of the genetic basis for mental illness was that well understood, developing gene therapies to turn it off wouldn't be that much farther ahead.  

We're nowhere close to that. 

[Hopelessly Broken]

Agreed. 

[Postictal]

If anyone is interested, here are my results for the psychotropic genetic test. It's interesting.

I've taken a good portion of the meds on those lists, except the "Use as directed" list - the only one of those that I've tried is Pristiq, which is what I'm on now.

For antipsychotics, on the "use as directed list", I've used saphris (works well but can't get past the horrid taste), Invega (well, Invega Susstena, an injection. It worked well but I gained 30lbs in a month...willing to try it again, though, but pills this time), and Geodon (worked great for years, but now due to some other reasons which I wont get into, it doesn't work well enough for me anymore because it needs to be taken with a full meal to be fully absorbed, which I can't do because I can't eat enough at once)... I have not tried Latuda, but may do so, because I'm on clozaril right now and it's making me super hungry for sweets so I'm eating too much junk, plus it makes me sleep a ton.

In light of the results, I may try Latuda and Fetzima. I'm just not sure yet. My pdoc asked what I wanted to do, but I said I'm not sure...so he said to mull it over and let him know if I want to change meds or not.

Pristiq helps some but it is only available in extended release, which I can't absorb properly because of a surgically modified GI tract, so I'm not able to get the full benefit.

[IcePrincess88]

I just did this test in pdocs office today.  He said results should be in by next week.

I'd love to know your results!

 

I have never heard of this test, but that seems to be some amazing technology! I do have Medicaid too. The only down side is, I've tried ALOT of medications. Even more than my siganature says, because my memory is shot and I can't remember them all.

[melissaw72]

Postictal ... thanks for posting ... that is really neat!  I can't wait to get my results! 

[Postictal]

I just did this test in pdocs office today.  He said results should be in by next week.

I'd love to know your results!

 

I have never heard of this test, but that seems to be some amazing technology! I do have Medicaid too. The only down side is, I've tried ALOT of medications. Even more than my siganature says, because my memory is shot and I can't remember them all.

I posted the results in the post before yours, lol.

[IcePrincess88]

I was talking about melissaw72 's results.

As for your results, to make sure I'm understanding this correctly: The medication under "Use as directed" is what the test says is the best for you? And the "Use with caution" are the ones that may or may not work good? And on the right hand side, are the medications that probably won't work for you?

I can't believe I've never heard of this test, or that it's never been offered to me. This is some really cool science! Does the test not include medication for anxiety, like benzos? And you say no blood is required either? Fantastic! How long did it take to get your results? Was it mailed to you or your pdoc?

[melissaw72]

^^No blood is required.  It is a cheek swab ... you swab the inside of each cheek 10 times each side, mail that via FedEx, and supposedly you get them within a week.  I'll find out tomorrow.  Your pdoc also has to register you on their website.  The results (AFAIK) will be/have been mailed to him.

[Fluffypinkbunny]

This is really cool!  Thank you for sharing.  I'm asking my new pd about this on Friday.

[melissaw72]

I got my results back yesterday, and they found that my body does not process folic acid the right way, so after vacations etc this summer my pdoc is starting me on Deplin, which is a type of folic acid that crosses the blood brain barrier.  Not sure how else it works.  There were 2 meds that my pdoc might actually change because they are in the category that says use with extreme caution.  Or at least one ... the abilify ... I am on such a high dose (45 mg/day) and he said that might be a problem.  Prozac was the other one.

[Velvet Elvis]

I still say this is useless.

If you take more than one med at a time that's metabolized by the liver it's all thrown to hell.  If you have a beer it's all thrown to hell.  Nothing about it tells you what meds will work or not.  It just gives an idea about what dose ranges might be most effective.  

[Velvet Elvis]

I was talking about melissaw72 's results.

As for your results, to make sure I'm understanding this correctly: The medication under "Use as directed" is what the test says is the best for you? And the "Use with caution" are the ones that may or may not work good? And on the right hand side, are the medications that probably won't work for you?

I can't believe I've never heard of this test, or that it's never been offered to me. This is some really cool science! Does the test not include medication for anxiety, like benzos? And you say no blood is required either? Fantastic! How long did it take to get your results? Was it mailed to you or your pdoc?

No, this says absolutely zero about the potential effectiveness of a medication.  All this tells you is how fast your liver will metabolize it.  It might help with dosing, but it's still voodoo.

 

[Velvet Elvis]

All this tells you is how long it will take your liver to remove a drug from your bloodstream.  It says nothing about how a drug will work in your brain.  It says nothing about how effective any medication might be.

I'm still calling it borderline insurance fraud.

 

[Indigo 'n dye]

All this tells you is how long it will take your liver to remove a drug from your bloodstream.  It says nothing about how a drug will work in your brain.  It says nothing about how effective any medication might be.

I'm still calling it borderline insurance fraud.

 

Prediction, fortunetelling, prevision now covered by insurance companies and sworn to by docs. If something seems to good to be true...

[IcePrincess88]

I was talking about melissaw72 's results.

As for your results, to make sure I'm understanding this correctly: The medication under "Use as directed" is what the test says is the best for you? And the "Use with caution" are the ones that may or may not work good? And on the right hand side, are the medications that probably won't work for you?

I can't believe I've never heard of this test, or that it's never been offered to me. This is some really cool science! Does the test not include medication for anxiety, like benzos? And you say no blood is required either? Fantastic! How long did it take to get your results? Was it mailed to you or your pdoc?

 

No, this says absolutely zero about the potential effectiveness of a medication.  All this tells you is how fast your liver will metabolize it.  It might help with dosing, but it's still voodoo.

 

Dangit! I knew this sounded too good to be true.

[Lynn201]

I actually had this done about a month ago and found it to be extremely helpful.  First of all it tells you which meds may increase the risk of side effects for you, which can be really helpful for people who experience a lot of side effects.  Secondly, it tells you when you might need lower or higher doses of a drug based on the way particular genes and their enzyme activity metabolizes the drug.  In reference to the whole efficacy issue, I think genesight can be helpful in determining which meds are likely to "work" or not, but unfortunately just because a medicine is in the green/ "good" column doesn't automatically mean the med will work for you; and just because a med is in the red/ "bad" column doesn't automatically mean the med will be ineffective.  HOWEVER, some meds do have footnotes next to them saying that you might have reduced efficacy of the drug based on your geneotype.  For example, I have several medications in the red category that are not there based on reduced efficacy but because of a higher risk of side effects or because the serum level of the drug may be too low, requiring me to take higher doses, which may increase side effects and/or mean I'd have to take a higher dose than recommended.  

I agree the test is not magic, and would be more helpful if it told you which meds ARE likely to be the most effective, but knowing which meds may be less effective certainly narrows down the options and makes picking a med less daunting. Just to give an example, out of the 22 antidepressants listed, my test indicates 4 are likely to be ineffective for me, and 4 others are in the red column for other reasons, leaving 8 less medications to waste time and money trying.  The test also cannot tell you what combo of meds might be helpful or how certain meds might interact.  Furthermore, I wish the test dealt with anti-anxiety meds but it does not.

But for me, what it tells me about which meds might require higher or lower doses for me has been one of the most beneficial parts of test, as it can often be hard to tell if the med is ineffective or the dose has to be raised.  Or if you are just prone to side effects from a particular med or need to take a lower dose.  This in addition to narrowing down meds based on efficacy and analyzing how my body has reduced folic acid conversion (if your body has significantly reduced folic acid conversion, you can take all the meds in the world and they probably won't help) have made the test worth it FOR ME. 

As for the price, the company has a financial assistance program which can make it very cheap if you qualify.  Unfortunately, I was declared as a dependent on my parent's  taxes last year, so my income level  was based off their income as opposed to mine, so I did not qualify.  I have not yet received a bill from genesight to see how much my insurance did not cover (I THINK you can be liable for up to $300), so other than above I cannot say much about the cost.  

So basically, I would look at your individual situation and not be so quick to dismiss the genesight test, because I have found elements to be very beneficial.  

[melissaw72]

I actually had this done about a month ago and found it to be extremely helpful.  First of all it tells you which meds may increase the risk of side effects for you, which can be really helpful for people who experience a lot of side effects.  Secondly, it tells you when you might need lower or higher doses of a drug based on the way particular genes and their enzyme activity metabolizes the drug.  In reference to the whole efficacy issue, I think genesight can be helpful in determining which meds are likely to "work" or not, but unfortunately just because a medicine is in the green/ "good" column doesn't automatically mean the med will work for you; and just because a med is in the red/ "bad" column doesn't automatically mean the med will be ineffective.  HOWEVER, some meds do have footnotes next to them saying that you might have reduced efficacy of the drug based on your geneotype.  For example, I have several medications in the red category that are not there based on reduced efficacy but because of a higher risk of side effects or because the serum level of the drug may be too low, requiring me to take higher doses, which may increase side effects and/or mean I'd have to take a higher dose than recommended.  

I agree the test is not magic, and would be more helpful if it told you which meds ARE likely to be the most effective, but knowing which meds may be less effective certainly narrows down the options and makes picking a med less daunting. Just to give an example, out of the 22 antidepressants listed, my test indicates 4 are likely to be ineffective for me, and 4 others are in the red column for other reasons, leaving 8 less medications to waste time and money trying.  The test also cannot tell you what combo of meds might be helpful or how certain meds might interact.  Furthermore, I wish the test dealt with anti-anxiety meds but it does not.

But for me, what it tells me about which meds might require higher or lower doses for me has been one of the most beneficial parts of test, as it can often be hard to tell if the med is ineffective or the dose has to be raised.  Or if you are just prone to side effects from a particular med or need to take a lower dose.  This in addition to narrowing down meds based on efficacy and analyzing how my body has reduced folic acid conversion (if your body has significantly reduced folic acid conversion, you can take all the meds in the world and they probably won't help) have made the test worth it FOR ME. 

As for the price, the company has a financial assistance program which can make it very cheap if you qualify.  Unfortunately, I was declared as a dependent on my parent's  taxes last year, so my income level  was based off their income as opposed to mine, so I did not qualify.  I have not yet received a bill from genesight to see how much my insurance did not cover (I THINK you can be liable for up to $300), so other than above I cannot say much about the cost.  

So basically, I would look at your individual situation and not be so quick to dismiss the genesight test, because I have found elements to be very beneficial.  

^^THIS.  Great explanation.  

FWIW, Medicare covers it.

[Velvet Elvis]

There's  a problem with this though.  It may be that the only med that would work for you is one that the test would say has side effects.  A lot of people would rather just deal with the side effects than have a med that doesn't work.

Also, the dose at which a medication might be effective is going to be hugely variable, regardless of what the test tells you. 

Somebody seeking to save money for medicaid got a bill passed requiring this kind of testing in an attempt to save money, but the evidence is very inconclusive that it's helpful and may in fact lead to the proper treatment being wrongly excluded from consideration.

I'm still looking for an article a read a few months ago on this.

 

There is still a lot of tea leaf reading involved in interpenetrating the results, and IMHO it's unethical to give the results directly to the patient because they lead to a false sense of security like we're seeing from everybody here that's had the damn test.

 

This is about genesight in particular:

http://www.thecarlatreport.com/free_articles/genesight-genetic-test-review-evidence-free-article

If we were to hold the GeneSight test to the usual standards we require for making medication decisions, we’d conclude that there’s very little reliable evidence that it works. On the other hand, some of you will probably want to try it out, especially for those patients who have insurance that will cover the cost of the test. If you do order it, reserve it for patients who are most likely to benefit, including patients who have failed to respond to multiple medications (which could be caused by ultra-rapid metabolism, causing drug levels to be too low), and patients who have had lots of side effects (potentially caused by slow metabolism, causing drug levels to he too high). 

More here:

 http://www.medscape.com/viewarticle/760575

Edited September 21, 2015 by Velvet Elvis

[melissaw72]

FWIW, the results are ONLY given to the DR.  It is up to the DR whether s/he wants to show them to you.

If you do order it, reserve it for patients who are most likely to benefit, including patients who have failed to respond to multiple medications (which could be caused by ultra-rapid metabolism, causing drug levels to be too low), and patients who have had lots of side effects (potentially caused by slow metabolism, causing drug levels to he too high). 

Isn't this saying that the test might benefit patients who have failed to respond to multiple meds ... and patients who have had lots of side effects ... ?  It might not be for everyone, but in some cases it could be helpful, like the quote says.

From the medscape link above, the abstract says:

The identification of genetic biomarkers that predict antidepressant-treatment response can improve current clinical practice. This is an emerging field known as pharmacogenetics, which comprises of genetic studies on both the pharmacokinetics and pharmacodynamics of treatment response. Recent studies on antidepressant-treatment response have focused on both aspects of pharmacogenetics research, identifying new candidate genes that may predict better treatment response for patients. This paper reviews recent findings on the pharmacogenetics of antidepressant drugs and future clinical applications. Ultimately, these studies should lead to the use of genetic testing to guide the use of antidepressants in clinical practice.

Maybe I'm understanding this wrong, but from the medscape abstract and the other link posted, they talk about how it might be helpful in come cases (see in bold).

[Velvet Elvis]

The medscape link says it may be helpful in the future.

The CR article says it's useless now.

 

It's also completely unethical how this shit is being marketed to physicians on the basis of really sketchy clinical data.

 

[Savannah]

Melisa,my pdoc had me try deplin for an additive for depression. I didn't notice any difference.

[melissaw72]

Melisa,my pdoc had me try deplin for an additive for depression. I didn't notice any difference.

Are you referring to adding it because of gene testing? With the testing my pdoc didn't add anything, but is keeping an eye on how certain meds of mine interact and cause increased side effects of each other.

[Chrisja1987]

On June 10, 2015 at 10:12:47 PM, Postictal said:

I saw my psychiatrist yesterday. I have been on tons of meds, and I'm still depressed. This time, he brought up something new - genetic testing. I was like, huh? For what? I thought I knew about all the options out there. But there is something that just came on the scene...

First of all, he wants to do the MTHFR genetic test. My understanding is that people with a specific genetic marker are likely to have problems metabolizing folic acid properly into L-Methylfolate. Your blood levels of folic acid may be normal, but some people cannot properly break down the folic acid into L-Methylfolate, which is a form that can pass the blood brain barrier. If your brain doesn't get the L-Methylfolate, it can cause treatment resistant depression. And this can be treated with a "medical food" (basically like a vitamin, but a prescription is required) which is pure L-Methylfolate. 

ALSO there is another test he ordered, and this one BLEW MY MIND. It's a genetic test that will tell which antidepressants and antipsychotics are most likely to work for you, which ones should be avoided or watched very closely because you're likely to have side effects, or ones that you're likely to have a higher or lower serum level of, so you should be on a lower or higher dose, if you have a possible gene-drug interaction with that med, etc. 

The company that does this is called GeneSight. It's in the USA - have no idea about the UK or other places. The booklet they gave me says:

"Multiple clinical studies show that when doctors use GeneSight to guide their treatment, patients are twice as likely to get on the right medication. Plus, with treatment guided by GeneSight, patients saw a 70% greater improvement in their symptoms versus usual treatment."

I am on Medicare and medicare covers it 100% - which amazed the hell out of me. It must be useful if medicare will pay for it - they would only pay for it if it was proven to work and ended up saving them money in the long run.

The "test" doesn't even need blood - you just rub a cotton swab up against the inside of both cheeks. Easy peasy.

I haven't gotten my results yet, but I was amazed about this new option, so I figured I'd let people know that it's out there. You'd have to find a doc that has the test kits and such...I don't know, maybe if you contact the GeneSight company, they could tell you if any local providers participate in this.

I'll let you guys know when I get the results!

 

EDIT: Got my results! Result pics are in comments.

I did this test in the spring of 2014. I see you are an poor metabolizer of CYP2D6. Which is quit rare. I think around 75 percent of people are extensive (the ideal one) metabolizers. I infact am an ultra rapid metabolizer or CYP2D6. So you have no activity and I have insane amounts (only 1-2 percent of the world is this way)

Its funny how different people are you would take a 30 mg codiene pill and feel nothing as your body doesn't covert it to morphine due to being a poor metabolizer while I make insane amounts and could OD.

lifes funny like that I guess.

[Postictal]

On 12/1/2015, 7:54:55, Chrisja1987 said:

I did this test in the spring of 2014. I see you are an poor metabolizer of CYP2D6. Which is quit rare. I think around 75 percent of people are extensive (the ideal one) metabolizers. I infact am an ultra rapid metabolizer or CYP2D6. So you have no activity and I have insane amounts (only 1-2 percent of the world is this way)

Its funny how different people are you would take a 30 mg codiene pill and feel nothing as your body doesn't covert it to morphine due to being a poor metabolizer while I make insane amounts and could OD.

lifes funny like that I guess.

That explains a lot. Narcotic pains meds usually don't do much to me, but especially codeine. It does NOTHING at all. I usually request Toradol (a NSAID) for pain because it works best for me. Oxycodone knocks me out, but some things don't do squat. My first kidney stone, they gave me IV dilaudid...they said it was the max dose. It did nada except make my dizzy (only while they were injecting it)...toradol did great things when I requested it. Many opiates just don't do diddly squat for me.

[Chrisja1987]

8 hours ago, Postictal said:

That explains a lot. Narcotic pains meds usually don't do much to me, but especially codeine. It does NOTHING at all. I usually request Toradol (a NSAID) for pain because it works best for me. Oxycodone knocks me out, but some things don't do squat. My first kidney stone, they gave me IV dilaudid...they said it was the max dose. It did nada except make my dizzy (only while they were injecting it)...toradol did great things when I requested it. Many opiates just don't do diddly squat for me.

interesting, it could be you are a poor metabolizer of CYP2D6 maybe you should be tested. The only contradiction I can see to this is if codeine and other opiates do nothing for you oxycodone could do less then it would to others because it needs an active CYP2D6 to make the active drug Oxymorphone. although the parent drug oxycodone would still have any effect because not much oxycodone is change to oxymorphone unlike the codeine totally changing to morphine which gives the opiate effect.

I am not a doctor just a person who has tried to understand as much research as I can.

[Velvet Elvis]

Jesus fucking Christ.  

There is almost no research supporting this.  It's scam being pushed due to corruption, pure and simple. 

 

[Goodwill999]

It's common knowledge in the medical field that these tests will be used in the future. It saves insurance companies money because if the correct drugs are used there will be less visits to the ER, hospitals, etc 

[melissaw72]

 

On 9/21/2015 at 2:33 PM, Savannah said:

Melisa,my pdoc had me try deplin for an additive for depression. I didn't notice any difference.

I know this is a year-old thread, but I missed this post and wanted to thank you for letting me know about the deplin.  I never went on it, but it is good to know someone's experience who used it.

[JustNuts]

On 6/19/2015 at 10:08 AM, Velvet Elvis said:

I still say this is useless.

If you take more than one med at a time that's metabolized by the liver it's all thrown to hell.  If you have a beer it's all thrown to hell.  Nothing about it tells you what meds will work or not.  It just gives an idea about what dose ranges might be most effective.  

On 6/19/2015 at 10:10 AM, Velvet Elvis said:

No, this says absolutely zero about the potential effectiveness of a medication.  All this tells you is how fast your liver will metabolize it.  It might help with dosing, but it's still voodoo.

On 6/19/2015 at 10:19 AM, Velvet Elvis said:

All this tells you is how long it will take your liver to remove a drug from your bloodstream.  It says nothing about how a drug will work in your brain.  It says nothing about how effective any medication might be.

I'm still calling it borderline insurance fraud.

On 9/21/2015 at 3:02 AM, Velvet Elvis said:

There's  a problem with this though.  It may be that the only med that would work for you is one that the test would say has side effects.  A lot of people would rather just deal with the side effects than have a med that doesn't work.

Also, the dose at which a medication might be effective is going to be hugely variable, regardless of what the test tells you. 

Somebody seeking to save money for medicaid got a bill passed requiring this kind of testing in an attempt to save money, but the evidence is very inconclusive that it's helpful and may in fact lead to the proper treatment being wrongly excluded from consideration.

I'm still looking for an article a read a few months ago on this.

 

There is still a lot of tea leaf reading involved in interpenetrating the results, and IMHO it's unethical to give the results directly to the patient because they lead to a false sense of security like we're seeing from everybody here that's had the damn test.

 

This is about genesight in particular:

http://www.thecarlatreport.com/free_articles/genesight-genetic-test-review-evidence-free-article

More here:

 http://www.medscape.com/viewarticle/760575

I think you're being way too quick to condemn genetic testing. It's more useful than you seem to think it is. You claim it's borderline insurance fraud, yet several commercial insurers have voluntarily started covering genetic testing for psych meds (with some prerequisites) because it actually ends up saving them money. This is supported by the scientific literature. And by the FDA - which has been encouraging the use of pharmacogenetic and pharmacogenomic testing for a number of drugs (http://www.fda.gov/Drugs/ScienceResearch/ResearchAreas/Pharmacogenetics/ucm083378.htm). The main catches are that:

A) This is generally only supported for a certain patient population (primarily treatment-resistant patients) and/or certain drugs (see the linked list)

B) It is unclear if tests that fail to assess CNVs are still providing appropriate value (primarily in the context of assessing the CYP2D6 phenotype)

C) This applies only to pharmacogenetic/pharmacogenomic testing in the context of certain medications - not to things like mthfr mutation testing (which is frequently misused and may or may not be worth the expense), or more experimental testing (although that can be appropriate as a secondary source of guidance in some cases).

On 9/21/2015 at 7:32 AM, Velvet Elvis said:

It's also completely unethical how this shit is being marketed to physicians on the basis of really sketchy clinical data.

I do agree that the marketing tactics used are generally somewhat unethical. But that does not change the fact that the results have significant value in certain cases.

On 12/6/2015 at 10:02 AM, Velvet Elvis said:

Jesus fucking Christ.  

There is almost no research supporting this.  It's scam being pushed due to corruption, pure and simple. 

This is hilariously wrong.

[notloki]

Many seem misinformed about these tests. People post that the test tells them which pill is best for them. No, actually the genetic tests can tell you how you metabolize some drugs. This is useful information to identify which drugs to avoid and guide dosing. This is a far cry from "We tested your genes and <whatever> drug is the answer to all your problems." That's the way things are represented on Internet boards I read.

[melissaw72]

9 hours ago, notloki said:

Many seem misinformed about these tests. People post that the test tells them which pill is best for them. No, actually the genetic tests can tell you how you metabolize some drugs. This is useful information to identify which drugs to avoid and guide dosing. This is a far cry from "We tested your genes and <whatever> drug is the answer to all your problems." That's the way things are represented on Internet boards I read.

Do you mean that the genetic testing could help identify which drugs to avoid and guide dosing based on the genetic testing and how a person metabolizes certain drugs? 

I'm sorry if I misunderstood.

Edited January 11, 2017 by melissaw72

[notloki]

8 hours ago, melissaw72 said:

Do you mean that the genetic testing could help identify which drugs to avoid and guide dosing based on the genetic testing and how a person metabolizes certain drugs? 

I'm sorry if I misunderstood.

At it's core I said " the genetic tests can tell you how you metabolize some drugs". You can interpret this information to identify which drugs the patient metabolizes quickly, moderately (or normal), or slowly.   

[melissaw72]

24 minutes ago, notloki said:

At it's core I said " the genetic tests can tell you how you metabolize some drugs". You can interpret this information to identify which drugs the patient metabolizes quickly, moderately (or normal), or slowly.   

That was what I thought you meant ... I agree with you. 

(Sorry ... Sometimes I have trouble with reading comprehension and I just need it worded another way to understand it).

[looking for answers]

On 6/19/2015 at 0:22 AM, melissaw72 said:

I got my results back yesterday, and they found that my body does not process folic acid the right way, so after vacations etc this summer my pdoc is starting me on Deplin, which is a type of folic acid that crosses the blood brain barrier.  Not sure how else it works.  There were 2 meds that my pdoc might actually change because they are in the category that says use with extreme caution.  Or at least one ... the abilify ... I am on such a high dose (45 mg/day) and he said that might be a problem.  Prozac was the other one.

did the folate fix the problem

On 6/19/2015 at 11:10 AM, Velvet Elvis said:

 

No, this says absolutely zero about the potential effectiveness of a medication.  All this tells you is how fast your liver will metabolize it.  It might help with dosing, but it's still voodoo.

 

well i can say lamictal showed as a drug i would need more of than a typical patient. i got up to 350mg, 150 mg over the max dosage. and i still wasn't half way to therapeutic blood levels. also some benzos that it shows i metabolize quickly i had taken the same days as drug tests and passed the drug tests. i believe

[Brittanyb*tch]

I had one done and thank god! The antidepressant I'm on that I have so many issues with (un fun ones like not being able to orgasm no matter what I try), is apparently not so good for me and so I can safetly come off of it after accidently causing myself to go into withdrawal. It makes the med process a little less experimenty. My AP tho is good and I'm glad because I've been so happy with its results, if you have it available, do it! The test can be super cheap. The company mine was done through has a sliding fee scale so I only have to pay $20 for $7,000 worth of testing. And I can be off antidepressants and just take methyl folate to boost my moods. 

[looking for answers]

min was sliding scale as well. it has helped explain why some meds don't work. however, mike did not do methyl folate!!