Psychiatric Times, July 17, 2017 By Rebecca M. Allen, MD, MPH
The open-label GeneSight and unblined Genomind studies are at high-risk for researcher bias and should be suspect to extreme caution. We would never allow anti-depressants to be approved with these kinds of studies (although unblinded/no-blind placebo psychotherapy studies are unreasonably and widely “accepted” as robust data by our profession all the time).
The issue of whether “adverse effects” are related to anxiety are easily investigated with zero-cost means. Patients’ significant others can manage all the medications, crush up the pills, and blind to the patient put them in patients’ morning small glass of orange juice. Do this a few days on and a few days off, keep a record, and see which days corresponded to the patient’s anxiety.
Regardless of a patient being a slow metabolizer, all patients should be started at low doses and can be told to break their starting dose pills in half, crush them, or empty capsules out so that every patient can start low and go slow for a number of days before going up to the low starting dose even. In addition, normal metabolizers may still have adverse effects at usual starting doses due to pharmacodynamics reasons (effects on the receptors etc in the brain) and not pharmacokinetic reasons (ie peripheral metabolism) which is not measured by metabolic genetic testing.
Proper clinical instruction and close follow up (which is necessary regardless of metabolic status) makes the use of these costly tests unnecessary in all but the rare patient with treatment resistance and/or those that have extreme reactions-only when drug is put in their OJ. I strongly suggest we never do a genetic test on any patient having “adverse reactions” on OJ with no drug in it and all the pills accounted for.
No genetic testing company is likely to be happy with what this advice may do to their market.
Doug Berger, MD, PhD
U.S. Board-Certified Psychiatrist
Tokyo, Japan
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