Genetic Testing for Psychiatric Drugs: Not There Yet
Just because you can do something doesn’t mean you should do it. Many of us could drive a bicycle on a freeway, but it wouldn’t be a wise thing to do. Many of us could pay money for “brain games,” but it wouldn’t necessarily help our brains’ health.
And so it is with genetic testing for psychiatric drugs. While you could pay for such a test to help you better understand how your body might react to certain psychiatric drugs, you’re probably better off not. At least not at this point.
There are two types of genetic testing available to people today: the kind that tests for your susceptibility to a particular kind of condition or disease, and the kind that tests how well you might do taking a particular class of medications. You should avoid the first test altogether, because no mental disorder is purely a genetic condition. While certain genetics may put you at greater risk for a disorder, our understanding of the causes of mental disorders are simply not there yet to do anything much of value with such genetic information.
The second kind of test — technically called pharmacogenetic testing — has more potential, as I wrote about earlier this year. It may be able to let us determine ahead of time which class of drugs a patient is more likely to respond positively to, reducing a patient’s symptoms. This would be a leap ahead of how psychiatric drugs are prescribed today, in a trial-and-error process for each patient.
But as I wrote in March:
This area is still in its infancy, however. Pharmacogenetic testing is not a cure-all, and it won’t guarantee that even if you try the first medication at the top of your personal list, it will work and be effective for your ADHD or depression symptoms (other disorders will be forthcoming in future years).
Seven months later, and things haven’t changed that significantly. Which is what the New England Center for Investigative Reporting’s Beth Daley has also discovered:
But a review by the New England Center for Investigative Reporting has found that virtually all the evidence that these psychiatric tests work is based on limited studies funded by the companies themselves or researchers they fund, including all five studies used to promote GeneSight on the company’s website.
The federal government doesn’t require companies to prove that this and thousands of other tests are accurate before marketing and selling them. Unlike drugs, the Food and Drug Administration does not regulate them, though that may soon change.
Some of the testing firms’ research practices also raise questions about potential conflicts of interest. […]
But psychiatric genetics remains in its infancy. Aggressive marketing and a lack of regulation of tests that have a thin scientific foundation have raised deep concerns for some bioethicists.
This is true of a lot of “brain science” these days — companies marketing their connection to science to suggest their product or service has a lot more research support than it actually does. This thin veneer quickly wears thin once you delve into the research, however. Many studies have small sample sizes with insufficient power to tell you much of anything.
Genetic Testing in Broader Context
While I don’t disagree with Daley’s report nor its findings, I would suggest that what genetic testing companies are doing research-wise is not dissimilar to how the pharmaceutical industry works. In order to conduct research on a product, a company usually hires outside researchers and clinics to actually conduct the clinical trials. There’s a host of good reasons why it’s done this way (e.g., most companies aren’t research experts; there’s an obvious, greater conflict of interest if the company itself actually conducted the research themselves; companies don’t have direct access to patients, since they don’t run clinics).
When contacted about this, Daley acknowledged that such a comparison was in an earlier version of the article, but got cut for space reasons (this article was originally published in The Boston Globe). That’s understandable, but a shame nonetheless since I think it would’ve given people a readily understandable comparison industry.
I was also concerned with the lack of equal representation of other, perhaps more positive stories about genetic testing for psychiatric medications. Daley reached out through a variety of methods — social media, advocacy organizations — to try to solicit stories and find people who would go “on the record” for the story.
What she got back, Daley says, was an overwhelming amount of stories from people who came away from the testing feeling uncertain if it helped them. Most felt it didn’t really do much good in their treatment. And for those who had to pay for it themselves, they were out $3,800. Compare that cost with that of a cholesterol test — under $100 — which provides direct, reliable, actionable information that will help your long-term health.
Genetic Testing for Psychiatric Drugs: Should You Try It?
Proove — one of the genetic testing companies mentioned in the article — calls itself the “research leader in personalized medicine.” However, this “leader” does not seem to have published a single study in a peer-reviewed journal since its inception (that I could find, anyway). And the research clinical trials it is undertaking weren’t registered with ClinicalTrials.gov until Daley started digging into the industry back in April of this year. Coincidence?
Daley’s article is a wake-up call to anyone considering this sort of test. Genetic testing companies market the tests in such a way to suggest they are more reliable and useful than they really are (at least today). We are still not there yet with the research.
Understanding the limitations of the research helps to inform a patient’s decision-making process. These tests aren’t a cure-all, nor will they offer any kind of guarantee that switching medications is going to help a person. Think about that long and hard before you decide to agree to taking or purchasing one.
Join NECIR’s Senior Investigative Reporter Beth Daley, Huffington Post Healthy Living Editor Erin Schumaker, and a panel of psychiatry experts to answer your questions about this emerging industry in mental health care.
For further information
New England Center for Investigative Reporting: More harm than good?
The Boston Globe: Genetic tests for psychiatric drugs spur hope, doubts
Grohol, J. (2018). Genetic Testing for Psychiatric Drugs: Not There Yet. Psych Central. Retrieved on April 7, 2020, from https://psychcentral.com/blog/genetic-testing-for-psychiatric-drugs-not-there-yet/