For many years, psychiatry has looked to various approaches to gain a deeper understanding of mental disorders. In the 20th century, one of the major shifts in psychiatric care resulted in a movement toward deinstutionalization. Today, another paradigm shift has emerged, thanks to advances in both science and technology.
Although the use of genetic testing in mental health care must be used carefully and in the appropriate context, it is paving the path forward for many people. As the scientific world continues making strides in genomics, personalized medicine has become a true possibility. The study of human genes has opened the door to healthcare advancements in treating many types of cancer and genetic disorders.
Advances in genetic testing have also ushered in a new era of precision medicine in psychiatry. In allowing psychiatrists to gain deeper insights into the biological foundations of mental health disorders, genetic testing has opened the door to improvements in personalized psychiatry.
The Genomic Revolution
The Human Genome Project was a biological voyage that spanned more than a decade. The team of international researchers worked from 1990 until April 2003, and their work in studying the human genome along with their accomplishments throughout the project have provided pivotal insight into human biology. Although the project revolutionized medicine across many disciplines, it specifically had a critical impact on psychiatry.
Understanding all 50,000 to 100,000 genes in the human genome provides a window into the biology of disease. It also allows for the development of improved diagnostic tests and paves the way for better treatment options moving forward.
Combined with many researchers’ strong beliefs, evidence has been present for some time that many major psychiatric conditions have a genetic component. Thanks to the genomic revolution, mental health practitioners have new tools at their disposal. While genetic testing is not yet available for patients, it is one of the future developments in the field. For the millions of patients suffering from mental health conditions, new hope is on the horizon as personalized psychiatry becomes increasingly prevalent.
Genetic testing can help identify risk factors for particular diseases by looking for specific genetic biomarkers. In doing so, it can help identify people in the early stages of a disease or those at high risk of developing certain diseases. It is not currently being used in clinical practice, it is the shape of things to come.
Genetic biomarkers have been used in healthcare for a while now. For example, women can be tested for the genetic markers BRCA1 and BRCA2 that are associated with breast cancer to assess their long-term risk of developing the disease.
Genome biomarkers can determine if an individual carries the genes that predispose them to psychiatric conditions, as well. This can improve the ability to diagnose conditions and facilitate early intervention for mental health. It’s also useful for refining treatments and potentially matching patients with other types of treatments, such as nutraceuticals.
Pharmacogenomics is a young, growing field that explores the intersection of genetic variations and the interactions and effects of medications. It has the potential to produce treatments with maximum benefits and minimal negative effects. Pharmacogenomics could solve the mystery behind why medications affect people differently. As a result, it can improve outcomes and help patients achieve effective therapeutic dosages more quickly.
The Clinical Pharmacogenetics Implementation Consortium (CPIC) and other agencies, including the U.S. Food and Drug Administration (FDA), have already identified several genes that are useful in this area, including:
- CYP2D6, which can affect drugs like Atomoxetine and various antipsychotics and antidepressants
- CYP2C19, which can affect drugs like tricyclic antidepressants, Sertraline, Escitalopram, and Citalopram
- CYP2C9, which can affect Phenytoin and Fosphenytoin
- HLA-B*15:02, which can affect drugs like Lamotrigine, Carbamazepine, Phenytoin, and Oxcarbazepine
- HLA-A*31:01, which can affect Carbamazepine
Personalized Treatment Plans
With the vast, deep insight that genetic testing can provide, opportunities to tailor treatment approaches to each individual patient are possible. This provides a means beyond just physical examinations and reviewing a patient’s medical history to determine treatment. Given the degree of inheritability of many mental health conditions, adding mental health genetic testing to the mix can offer increased personalization and precision.
Finding the appropriate medication and the right dosage to treat mental illnesses often takes time, trial, and error. What works for one patient may not work for another, or some effective treatments may produce negative side effects. Genetics are among the factors that determine how someone reacts to medications. Using genetic testing to help select medications can help physicians produce targeted results that are more effective. This is the future of the field and is still in development.
Mental health genetic testing alone cannot confirm a psychiatric diagnosis. It is, however, a tool psychiatrists can use for diagnoses and early intervention. This may lead to an increase in patients benefiting from psychotherapy. This treatment modality can help individuals cope with stress, change troubling thoughts and behaviors, and get the support they need. As genetic insight has the potential to improve the efficacy of medications, it may also prove useful in a psychotherapeutic setting.
Lifestyle and Environmental Factors
Genetics aren’t the only factor at play in the mental health arena. Research, including studies on families and twins, has demonstrated that nature and nurture both play roles in mental disorders. This is one of the reasons that genetic testing alone doesn’t provide a complete picture into a patient’s mental health. Environmental factors, stress, and trauma can all increase someone’s chance of developing a mental illness. Other elements, such as genetic mutations and genes that may increase individuals’ resilience to mental health conditions, can also play a fascinating role.
Just as genetic testing can allow for healthcare providers to intervene before a patient develops a health condition, it can also facilitate early intervention for mental health concerns. In turn, it may empower psychiatrists to prevent patients from developing disorders or delay the onset of them.
Personalized psychiatry and the use of genetic testing in mental health has a host of advantages and benefits. It also introduces significant ethical considerations that cannot be overlooked. For example, the need to regulate testing has led to a flurry of legislative efforts to maintain control and oversight over these tests.
More importantly, genetic insight can produce valuable benefits for treatment. However, psychiatrists and other mental health professionals must take care to safeguard patient’s privacy and data security. Other considerations include:
- Results require interpretation from skilled professionals.
- Everyone involved must remember that genetic testing can provide on piece of information in an otherwise multidimensional picture.
- Genetic testing and clinical evaluations must work collaboratively.
- Pre-symptomatic testing has the potential to create stigma and discrimination.
- Using genetic testing in psychiatry can have broad implications for individuals and families.
The Future of Personalized Psychiatry
Pharmacogenomics and genetic testing are still new and growing fields. Although experts and professionals still have much to learn and discover, these options offer an incredible opportunity to personalize health care at a high level. Using genetic profiles can help improve early intervention efforts and tailor treatments for greater efficacy.
If you or someone you care about is dealing with a mental health disorder, there is hope and help available. Dr. Manuel Astruc, M.D. is a preeminent psychiatrist in Saratoga Springs, New York, offering comprehensive and innovative services to help patients regain control of their lives.
Learn more about the treatment options and support available to you by calling 518-255-7164 today.