Brain Science and Updates From the Field

New gene mapping tool used for medication selection

Thursday, November 13, 2014

Stairways doctors are now using cutting-edge genetic testing for a personalized approach to prescribing medicine for appropriate clients.

Pharmacogenomic testing identifies individual genetic differences and how they relate to medication response. Because genes influence the way a person’s body responds to specific medications, they may not work the same for everyone.

While not standard procedure for all clients of Stairways’ prescribers, this simple cheek swab has helped doctors determine the next best step for clients who have tried multiple psychotropic medications without success, or for whom side-effect risks are too high with certain medicines.

Genetic testing is a welcomed new instrument for solving a traditionally difficult situation. According to Lisa Hillman, co-director and nursing manager of Stairways’ Erie Outpatient Clinic, some clients express frustration while enduring repeated introduction phases for new medications.

The following scenario is common, said Hillman.

“A client will try one prescription, wait the required time for that medication to take effect, feel no improvement in symptoms and work with their doctor to try dosage adjustments – but ultimately that drug can fail, simply based on the person’s body chemistry.”

Often, the failure of one medication helps a doctor to know exactly which to try next. But some cases are more difficult. When repeated attempts with new medicines fail, turning weeks into months without successful symptom management, a new method is in order.

The genetic testing process is simple, and the results are clear. Under the supervision of a medical assistant, “Clients perform the cheek swab themselves; their doctor fills out the order, FedEx picks up the package same-day and five days later we’ve got the findings,” said Hillman.

Test findings provide results according to three categories: GREEN under the heading “Use as Directed,” YELLOW drugs are to be “Used With Caution,” and RED medications are suggested only for “Use With Increased Caution and With More Frequent Monitoring.” Both cautionary levels include notes specific to the chemistry as indicated by an individual’s DNA, e.g. “genotype may impact drug mechanism of action and result in reduced efficacy.”

GeneSight, the name of the test used in Stairways’ clinic, was developed in the Assurex Health clinical laboratory of Mason, Ohio and is based on patented technology licensed from the Mayo Clinic and Cincinnati Children’s Hospital Medical Center, who continue to be research collaborators. In August, 2014, the laboratory celebrated their 100,000th North American patient test.

More recently, Assurex Health and Canada’s Centre for Addiction and Mental Health (CAMH) today announced they have received a $6 million grant from Genome Canada, an agency of the Canadian government, to study the benefits of genetic testing to guide specific medication decisions for patients with depression or schizophrenia.

Stairways began limited GeneSight testing in April, 2014, and its use is slowly growing in frequency. “Some places jump right into this, testing every client,” said Hillman, “whereas we see tests ordered for about three to five individuals per week.”

This growth may increase more rapidly, due to favorable results, the growing body of research and educational information available to doctors – and one important fact for Stairways clients: the test is covered under both Medicare and Medicaid insurance.

This is important to Hillman as well, who has watched GeneSight provide a new opportunity through an historical stumbling block. “Many of the people we serve could not afford the out-of-pocket fees associated with DNA testing or genome mapping. But this is right in the reach of people who need it; the benefits of these tests are designed specifically to address the symptoms and risk profile of our clients.”

(Additionally research and information about GeneSight and pharmacogenomic testing can be found here: www.genesight.com)


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