Clinical Diagnostics

PGxInsight - Psychiatric Disorders

Treatment resistance in patients medicated for depression or anxiety is more common than treatment response, and generates significant financial burden. Psychiatric pharmacogenomics improves psychotropic medication treatment by analyzing polymorphisms in genes that affect the metabolism of and response to antidepressant and antipsychotic medications . The International Review of Psychiatry recently published an extensive review validating the clinical use of pharmacogenomic testing to help predict patient response to psychiatric medications and improve treatment outcomes (Altar et al. 2013). The paper provides substantial evidence that psychiatric pharmacogenomic testing has clinical value in predicting how individual patients will tolerate and respond to specific psychiatric medications . The article reviewed published data collected since 2007 examining how DNA sequence variation between individuals affects metabolism and response to medications. The evidence from these studies supports the validity of analyzing patients' genetic profiles to predict the metabolism, safety, and therapeutic efficacy of psychotropic medications commonly used for the treatment of depression, schizophrenia, and bipolar disorder. In psychiatry, about 52% of the psychiatric and 62% of antidepressant or antipsychotic drugs are metabolized by CYP2D6. Tests offered by Retrogen include the CYP2D6, CYP2C9, CYP2C19, CYP3A4, CYP3A5, CYP1A2, OPRM1 and COMT genes.

Available Tests
Psychotropic Panel
Documents
Info Sheet  Requisition Form 
Test Information
Genes: CYP2D6, CYP2C9, CYP2C19, CYP3A4, CYP3A5, CYP1A2, OPRM1, COMT, DRD2
Clinical Utility:
Method: Polymerase Chain Reaction and Sanger Sequencing
Ordering
Test ID: #9003 Cardiovascular Panel
Turn-around Time: 5-8 days
Preferred Specimen: Buccal swabs
Billing
CPT Codes: 81479
Billing Information: View Billing Information
References
  1. Thase ME. STEP-BD and bipolar depression: what have we learned? Curr Psychiatry Rep 2007; 9: 497-503.
  2. Kung S, Xiaofan L. The clinical use of pharmacogenomic testing in treatment-resistant depression. Prim psychiatry 2010; 17: 46-51.
  3. Mulder H, Heerdink ER, van Iersel EE, et al. 2007. Prevalence of patients using drugs metabolized by cytochrome P450 2D6 in different populations: a crosssectional study. Ann Pharmacother. 41:406-413.
  4. Altar CA, Hornberger J, Shewade A, Cruz V, Garrison J, Mrazek D. 2013. Int Rev Psychiatry. Clinical validity of cytochrome P450 metabolism and serotonin gene variants in psychiatric pharmacotherapy. 25:509-33
  5. Mrazek DA. 2010. Psychiatric pharmacogenomic testing in clinical practice. Dialogues Clin Neurosci. 12:69-76. Review.
  6. Angst MS, Phillips NG, Drover DR, et al. Pain sensitivity and opioid analgesia: a pharmacogenomic twin study. Pain. 2012;153(7):1397-409.
  7. Reynolds KK, Ramey-Hartung B, Jortani SA. The value of CYP2D6 and OPRM1 pharmacogenetic testing for opioid therapy. Clin Lab Med. 2008;28(4):581-598.
  8. Webster LR. Pharmacogenetics in pain management: the clinical need. Clin Lab Med. 2008;28(4):569-579.
  9. Droney J, Riley J, Ross J. Opioid genetics in the context of opioid switching. Curr Opin Support Palliat Care. 2012;6(1):10-16.
  10. Jannetto PJ, Bratanow NC. Pain management in the 21st century: utilization of pharmacogenomics and therapeutic drug monitoring. Expert Opin Drug Metab Toxicol. 2011;7(6):745-752.
  11. Eichner et al. Apolipoprotein E polymorphism and cardiovascular disease: a HuGE review. Am J Epidemiol. 2002, 155(6):487-95.
  12. Koch et al. Apolipoprotein E gene epsilon2/epsilon3/epsilon4 polymorphism and myocardial infarction: case-control study in a large population sample. Int J Cardiol. 2008, 125(1):116-7.
  13. Zhou SF. Polymorphism of human cytochrome P450 2D6 and its clinical significance: Part I. Clin Pharmacokinet. 2009;48(11):689-723.
  14. Zhou SF. Polymorphism of human cytochrome P450 2D6 and its clinical significance: part II. Clin Pharmacokinet. 2009;48(12):761-804.