With the explosion of genetic testing and the emerging field of pharmacogenetics, patients can now take a DNA test and receive psychiatric drug recommendations customized to fit their genetic makeup. In an editorial for the latest issue of the Journal of Nervous and Mental Disease, Columbia University Psychiatrist Robert Klitzman warns that clinicians need to be aware of the limitations of these genetic tests being sold to them.
“Several tests are now being marketed to psychiatrists, based on reports of genetic markers found to be associated in various samples of patients with a range of psychiatric conditions,” Klitzman writes. “But the replicability and clinical utility of these have been limited.”
For-profit companies can legally develop these tests and market them directly to psychiatrists without demonstrating their effectiveness or receiving FDA approval. “The policy that permits marketing of such tests has raised controversy, in part because federal agencies do not ordinarily undertake post-marketing surveillance of these tests.”
Klitzman adds that this direct-to-physician marketing can be particularly problematic in this case as many physicians “have a limited understanding of genetics, and may thus accept, rather than question these companies’ claims.”
For instance, several tests are currently being marketed that claim that genetic markers have been identified that are associated with certain psychiatric diagnoses. However, Klitzman points out, that mental health conditions are influenced my much more than genetics, and can arise from “life circumstances and interpersonal and environmental interactions.”
Unfortunately, the marketing appears to be working. Klitzman reports that 41.6% of psychiatrists report having a patient ask about genetic testing in the last six months, and 14% have ordered these tests.
As these new genetic tests increase in use and visibility, the New England Center for Investigative Reporting (NECIR) reports that “the research behind them is scant, incomplete, or biased, and the potential for conflicts of interest is enormous.”
The subject of their investigation, a man from Vermont, was convinced by his doctor to take the tests and ended up suicidal and then institutionalized after following its recommendations.
More harm than good? Use of genetic mental health tests has grown rapidly. But evidence they work is scant. Beth Daley | New England Center for Investigative Reporting
The Need for Vigilance in the Marketing of Genomic Tests in Psychiatry. Klitzman R J Nerv Ment Dis.2015 Oct ; 203(10):809-810. PMID: 26421971 (Abstract)
When you know things are truly hopeless: the day you ask your psychiatrist to look into genetic tests to find the right neuroleptic for your “schizophrenia”.
Of course, the irony is these people don’t know just how down the rabbit hole they are.
As for this: “However, Klitzman points out, that mental health conditions are influenced my much more than genetics, and can arise from “life circumstances and interpersonal and environmental interactions.”
What an incredible revelation! Who would have ever thought…
The complexity of mind involves more than a knowledge of appearance objectives and a chasing of labels. Contemporary research is absolutely loaded with references that genetic testing does indeed help significantly, but not categorically so. This research is but one more example of throwing the baby out with the bathwater. One cannot go of half cocked thinking that *genetics alone* determines medication effectiveness.
Genetics must be considered in any treatment failure…. but failing clinically applicable genetic information the very next investigation much include IgG testing and in this Video Series: http://corepsych.com/gi – and for issues such as epigentic changes with transporter proteins take a look at this page: http://corepsych.com/walsh–resources
A serious issue: many who write for psych meds, while eager and conscientious, still think Prozac, with all it’s drug interactions [often based on those same genetic factors] is the standard antidepressant. Video: http://corepsych.com/2d6
I’m certain anyone looking at those genetic investigations can find problems – as the controls in that study very likely have no idea about IgG interferences with neurotransmission. Without controlling for multiple other contributory variables the researches can only speculate about what was missed.