Medically reviewed by, Russell Braun RPH
Imagine, taking a quick test to determine your genetic makeup and what antidepressant drugs would work the best for you. Sound too good to be true?
Some of the most widely prescribed medications are antidepressants. Unfortunately, many patients fail one or more depression medications before finding a cure, if they find one. That is where GeneSight comes in.
1. What is GeneSight Psychotropic test?
GeneSight is a company that offers tests that analyze your DNA looking for genes that may impact how certain drugs will work for a specific person. This type of testing is a new frontier in medicine that is referred to as pharmacogenomic testing.
Every person has differences in their genetic makeup. These differences could impact if one drug would work for you but not your friend or even family member.
GeneSight Psychotropic test combines analysis of your genetic makeup with something they call combinatorial pharmacogenomics. This is a fancy term for understanding how your metabolic pathway will make different drugs react in the body. The medications they analyze are for depression, but are often approved for other uses. Such as bipolar disorder, schizophrenia or post traumatic stress disorder (PTSD) to name a few.
2. What is a GeneSight test for?
The test is called GeneSight Psychotropic because in their genetic lab who looks at psychotropic drugs specifically. A psychotropic drug is one that affects a persons mental state. Therefore, GeneSight Psychotropic tests are only for mental health drugs, specifically depression.
There are 12 different genes that the GeneSight tests look for. Those 12 genes can be expressed in over 700,000 different combinations. These differences can impact how drugs are metabolized in the body. The way drugs are metabolized, or broken down, by the body can affect how well they work. Similarly, it can predict if adverse effects would be more likely as well.
Drugs for depression
Depression is a difficult disease to treat and the symptoms can severely impact quality of life. According to the Institute for Quality and Efficacy in Healthcare, antidepressants can improve symptoms about 20% more than placebo (a sugar pill).
The drugs used to treat depression work by changing the makeup of the synapses in the brain. This takes time to see these changes and often depression drugs are given four to six weeks to assess if they work or not.
3. What drugs are reviewed by the test?
The GeneSight test looks at 56 targeted drugs that are approved by the Food and Drug Administration (FDA) to treat depression and many of those drugs are approved to treat other mental health problems as well.
Drug classes that are included in the test results include:
- Selective Serotonin Reuptake Inhibitors (SSRI’s)
- Selective Serotonin & Norepinephrine Reuptake Inhibitors (SNRI’s)
- Tricyclic Antidepressants (TCA’s)
- Mono-amine oxidase inhibitors (MAOI’s)
- Atypical Antipsychotics
4. Potential benefits of the GeneSight Psychotropic test
If patients take a drug that is not going to work well for them due to metabolism problems, they can waste several months trying to find a drug that works best. First of all, there are dozens of medications available to choose from. Knowing ahead of time what drug(s) would work best could be a huge advantage.
Another concern is depression medications can be quite expensive. Therefore knowing the drug that may be a fit and cost effective is an important thing to know. If insurance covers the cost of the genetic test, it would seem like a no brainer to reduce the time and expense of trial and error with multiple drugs.
Finally, from a cost standpoint depression can be expensive. It has been studied and shown that depressed patients have more frequent emergency room visits. Inpatient hospital stays are also higher in this population. Treating depression and achieving remission can save money for the patients and the overall health system.
5. Is GeneSight accurate?
The GeneSight psychotropic test does NOT report back to your doctor the exact drug they should use. Rather, it provides a guide of which drugs they should avoid, use with caution or use as directed. These categories are color coded red, yellow or green to be easily understood like a traffic light.
|Color||What it means|
|Green||Use as directed|
|Yellow||Use with caution|
|Red||Increased risk, more monitoring required|
Avoiding the drugs falling in the red category help narrow in on the best drug for a particular patient. This would be good to eliminate drugs that likely would not work or would have the most potential for side effects.
Obviously, if there are drugs in the green category those would be best positioned to work for the patient and pose low side effect risk. The best practice would be to take those medications and see which is the most cost effective. However, GeneSight testing does not look at drug costs in the analysis. The GeneSight test does not skew results toward brand name drugs, so cheaper generic alternatives are on an even playing field.
Depression can be a hard disease to treat and for that reason many patients can end up taking multiple medications. When patients have to take more than one medication the likiehood of drug interactions increases. Knowing genetically how you metabolize drugs could be useful in this case.
6. Who should get a Genesight test?
Genetic testing may not help everyone find the best medication. The current test focuses on genes involved in depression medication metabolism. The target that is most influential is something called the CYP2D6 enzyme.
An enzyme is a substance produced by a living organism that acts to create a biochemical reaction. In the case of CYP2D6 and some other liver enzymes, they modify the structure of depression medications. If the gene that drives production of this enzyme is flawed, then antidepressant drugs will react differently than for people without the flaw.
- Most potential for improved drug selection
Patients with flawed CYP2D6 gene
- Least potential for improved drug selection
Patients with normal CYP2D6 gene
7. How do I get a Genesight test?
To get the GeneSight test your doctor will collect a painless cheek swab in their office. It typically takes less than five minutes. The saliva from the swab provides your DNA and the sample is sent to a Genesight lab for testing.
How long does it take go get the result?
The process only takes around two days before your doctor has the results. The report will be sent to your doctor so they can review it with you in order to make a decision on which treatment would be best.
The report will be sent electronically to your doctor and you should request a copy from them. Remember, email is not always secure and this is your medical information, just like anything else in your medical record. Therefore, an electronic medical record or chart where you can access the report may be the best idea.
Most people know that similarities in DNA runs in families. That is the reason people in the same family tend to look or act alike. However, that does not mean that a drug that works for you will be effective for other family members.
Just like we have unique physical attributes, the same is true for how individuals metabolize drugs.
9. Genetic information privacy
Believe it or not, there is a law that protects genetic information. The Genetic Information Nondiscrimination Act (GINA) is a law that protects individuals from genetic discrimination in health insurance and employment.
Basically, this law prevents an insurance company or your employer from dropping or firing you due to your genetic makeup.
10. Does the GeneSight test really work?
The GeneSight test does not give your doctor an exact plan for which drug will work for you. Rather, it points to drugs that could be a good fit based on specific genes. Therefore, some clinical research is needed to determine if the testing is really worth the cost.
GeneSight claims to be the only psychotropic test on the market to be validated in clinical studies. According to their website they claim the test helps double the likelihood of a response or remission for depression patients.
What does the research say?
A study published in Pharmacogenetics and Genomics from 2013 found improvements in depression scores for patients who had drug therapy guided by the test. However, this was a small study and not a double blind, randomized trial. Those type of clinical trials are the best way to ensure the outcome was correct.
Then in 2019 the Genomics Used to Improve DEpression Decisions GUIDED study was completed. It was a 24 week, double-blind, randomized controlled trial with 1,200 patients. The study looked for three outcomes.
- Remission, or elimination of depression
- Response, or some improvement in depression symptoms more than 50%
- Symptom reduction
The findings were that GeneSight testing did not significantly improve symptom reduction. However, there were significant improvements in response and remission rates. This was especially true for difficult to treat patients that had not had success with a previous depression medication.
Therefore, if you have never been treated for depression testing may not benefit you. In contrast, if you have tried and failed other depression medications, then taking the test could be beneficial. You would have to weigh that versus the cost of the test.
11. How much does GeneSight testing cost?
The test is expensive!
It can run up to $2500 for one test. That could be more than most people can afford for a test that is not guaranteed to provide relief from depression. The good news is that many insurers will now cover a portion of the cost. When insurance does not cover or your out of pocket expense is large there is a financial assistance program offered by Genesight, see below.
12. Is GeneSight testing worth the cost?
The reason some insurers have decided to cover the hight cost of this test is multifaceted. There are numerous costs associated with depression as it can lead to loss of productivity, increased healthcare costs such as emergency room visits and medication costs .
A study done by Genomid a company that competes with GeneSight in the mental health genetics space found significant savings. Overall they noted 40% fewer emergency room visits for all causes and 58% less inpatient hospital stays. The cost savings was estimated to be $2000 over a 6 month period. It is important to keep in mind that patients with this type of benefit are those who have had trouble treating depression in the past.
Genesight has also funded studies looking at cost savings. In particular they looked at patients treated over 1 year who had switched or added on a new medication for psychiatric or depression related problems. The cost savings for these patients was estimated to be almost $4,000 per year.
Many insurance plans will cover at least a portion of the cost of genetic testing. Especially, if you have tried and failed one treatment in the past. You may have to ask your doctor to complete a prior authorization process before the insurance will cover the test.
As laid out above if you are just receiving your first treatment for depression then you may want to wait to be tested. Furthermore, the insurance may not cover any portion of the costs if you have not tried a previous treatments.
Genesight claims 95% of patients pay less than $330.
Most patients will still have to pay a copay or deductible amount even if the test is covered. Remember the cost of the test can be up to $2,500 so if insurance asks you to pay $100 out of pocket that is still a good deal. If your out of pocket cost exceeds $330 then read below on the Genesight financial assistance program.
14. Medicare coverage
Medicare patient are in luck, because Genesight testing has been covered since 2014. A major reason for this is according to Centers for Medicare & Medicaid Services (CMS) 13% of beneficiaries over 65 reported depression symptoms. Furthermore, 46.7% of beneficiaries under 65 have symptoms of depression.
As people age (or are disabled) and have decreased mobility with more isolation depression can creep in.
The Veterans Affairs (VA) has also expanded coverage of the test for veterans who often suffer from depression after deployment.
GeneSight Psychotropic test was the first genetic testing to be covered under Medicare. With traditional plans the cost is $0. However, Medicare Advantage plans may require a copay or deductible from the patient. According to GeneSight this is typically less than $330, but if it exceeds that amount you can apply for the financial assistance.
15. Financial Assistance Program
GeneSight has a financial assistance program to help make the test more affordable for patients that may not have coverage. You must qualify to receive assistance and it is based on the following criteria:
- Household income
- Individuals in your household
- Federal guidelines
Don’t worry if your doctor sends a sample to Genesight before you determine your eligibility. They will hold your sample and not process it until they contact you & your insurer if the cost will be over $330. Genesight offers a customer service team to assist with enrollment, or go to www.GeneSight.com/cost. For times when the cost is over $100 they offer a payment plan.
Your insurer should process payment and send you an explanation of benefits before you receive a bill from GeneSight. Typically, financial assistance processing can take up to a month. These timelines often matchup well since it will take time for insurance to process the claim and get around to sending you a bill.
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Have you tried GeneSight or other genetic testing? Did it work well for you? Please chime in below with your comments and thoughts.