Have you or a family member felt like a Guinea pig in trying to find the right medication for anxiety or depression?  Is your child struggling with ADHD but can’t seem to tolerate the side effects of the medication?  Perhaps you feel that a family member could benefit from medication, but you’ve never made the jump because you’ve heard the horror stories?  Avoid the trial-and-error and consider a cheek swab for “inside” information about the best medication approach based on your genetics.  

Welcome to Personalized Boutique Psychiatry

Before I get ahead of myself, I should make it clear that I am a “therapy-first” psychiatrist and use medication as a last resort.  For the vast majority of patients that I treat, the sole purpose of medication treatment is to ensure that they are able to effectively do the work of talk therapy.  What’s most surprising to many patients is that the initial goal of the genetic test is to look at potential supplements that can be helpful prior to jumping straight to medications.  

MTHFR

For example, one of the genes that is examined is MTHFR, which is the enzyme responsible for converting Folic Acid (folate, a B-vitamin) to the activated form, L-methylfolate.  If you are a mom reading this, you probably recall the importance of taking prenatal vitamins for the development of your child’s nervous system - but in reality, this vitamin is important to each of us throughout our lifespan.  The activated L-methylfolate is used as a co-factor to make Serotonin, Norepinephrine, and Dopamine.  Serotonin and Norepinephrine are important for mood/anxiety and Norepinephrine and Dopamine help with focus/cognition.  Variants of MTHFR result in a production-line deficit that can be treated simply by adding the activated form of Folic Acid.  In fact, if medication is eventually needed, optimizing L-methylfolate can increase the likelihood that the medication will work.  

CACNA1C, ANK3, and BDNF

Similarly, genetic variants of Calcium Channel (CACNA1C) and Sodium Channels (ANK3) can cause mood and cognition issues.  Supplements like magnesium and SAMe can improve functioning by stabilizing calcium channels; Sodium Channel genetic variants can be optimized by adding Omega 3 fatty acids amongst others. In more severe cases, with great mood swings, introducing a mood stabilizers can be helpful.  

BDNF Met variants can highlight the need for exercise.  Many parents find it validating to show their child the science behind why they need to get off of video games and workout.  

Genetic Testing For Psychiatric Medications

Once supplements are optimized, medications may still be warranted.  In terms of choosing the right medication, genetic testing can help guide the path of choosing the most appropriate treatment:  

·      SLC6A4 can determine whether or not the generally accepted first line treatment for anxiety and depression, SSRIs, will be effective/tolerated – and may suggest the need to consider an alternative class of medication.  

·      ADRA2A and COMT can be helpful in choosing an ADHD treatment approach.  

·      COMT and SLC6A4 can help with treating trauma

·      MC4R and 5HT2C can predict if certain medications would cause weight gain. 

·      HLA-A and HLA-B genes look at whether or not an individual is at risk for a life threatening rash with certain medications.  

·      GRIK1 and OPRM-1 can help guide substance abuse treatment.  

·      Pharmacodynamic genes can help with dosing - i.e. there are multiple genes coding for the enzymes that break down the common psychiatric medications.  If testing reveals that a medication is broken down in the liver slowly or crosses the blood brain barrier quickly, the titration process should occur slowly to avoid side effects.    

Avoid the Trial and Error with Psych Meds!

I cant tell you how many times I hear that from a patient or family member who has struggled for years to find the correct medication regimen.  While testing helps tailor a treatment approach, it should always be used in conjunction with a thorough evaluation, and collaboration with other providers if possible.   If you do pursue genetic testing, you should also ensure your practitioner understands how to interpret the results.  I have a close friend who had a swab done and was told “pick any of the choices from the green column” by her PCP and had disastrous results.  I started doing genetic testing in early 2016 at “Best of Washingtonian” Potomac Psychiatry (if you live in the DMV area, I’d highly recommend their services) and extended my knowledge base in 2021 when I enrolled in The Fellowship In Functional Psychiatry, run by world reknown integrative psychiatrist, Dr. James Greenblatt, author of “Finally Focused: The Breakthrough Natural Treatment Plan for ADHD That Restores Attention, Minimizes Hyperactivity, and Helps Eliminate Drug Side Effects”

In all, I’ve swabbed and interpreted over 500 results and seen life-changing results in many cases.

Interested in getting tested to find the best antidepressant, anti-anxiety, or ADHD medication for you?  

Located conveniently in the heart of Chester County, near:

• Kennett Square, PA

• Unionville, PA

• Glen Mills, PA

• West Chester, PA

• Greenville, DE

• Wilmington, DE …and more!