Will a DNA test help me choose the best mental health medication?

When health care providers prescribe medications for depression, anxiety or other mental health conditions, there’s no one-size-fits-all approach — there’s an element of trial and error.

We make the best possible decision based on what we know about a patient, but we sometimes find that a medication doesn’t work as well as we had hoped, or that side effects are especially troublesome. We then might move on to a different medication.

Because it takes time for medications to have an impact, it might also take time for a patient to find relief or to know if the medication is the right fit for that person.

DNA tests can help reduce some of this trial and error by considering a person’s genetic makeup to show which medications might have the fewest side effects. But there are some things to think about when considering these tests.

What do DNA tests for mental health medications measure?

The goal is to better personalize mental health prescriptions. Ideally, these DNA tests determine how a particular person's body metabolizes and works with specific medications based on their genetic make-up.

That information can help guide us in deciding which medications to start off with, which ones we should avoid, and which might be more likely to produce side effects.

The tests tend to consider most of the major classes of psychiatric drugs. Patients receive reports that list different categories of medications, such as antidepressants, mood stabilizers, antipsychotics and anti-anxiety medications. They’re often grouped into three sets:

• those that would work well with your genetic makeup
• those that you could use with certain cautions
• those you should avoid

As an example of a caution in the middle set, it might note that someone is an “ultra-metabolizer” of a certain medication, meaning their body tends to break the medicine down faster than most people.

That might mean the medicine can’t do what it’s intended to do initially, so a physician might prescribe a higher dose than usual.

On the other hand, if someone is slow to metabolize the medication, meaning it doesn’t break down as well as expected, a physician might prescribe a lower dose than usual in hopes of minimizing the side effects while still getting the benefits of that medication.

Do DNA tests for mental health medications work?

There's a perception that there’s not enough research, not good-enough research or inconsistent results as to whether these tests are helpful. In other words, there may not be enough conclusive information right now to justify using this test for treatment decisions alone.

However, that doesn’t mean these tests are useless. Many patients do ask for the tests, and they can be one additional tool among many to help find the right treatment.

At this point, I wouldn’t classify these tests as a game-changer. More research is needed.

Why would I want to get a DNA test for mental health medications?

If it’s affordable for you, a DNA test might help your health care provider guide medications or dosages, especially if you’ve been on many different medications or tried many dosages. This may shed some light that helps a doctor make an informed decision.

The downside is that there are so many things that can affect whether a medication might work or not. So, just think of these tests as one piece of a larger puzzle and work with your health care provider to look at the whole picture to tailor a treatment plan right for you.

It can be frustrating when someone has had a mental illness for a long time and their treatments aren't helping. But it’s important to know that these tests aren’t yet an answer in and of themselves. They’re not going to fix everything.

How are DNA tests for mental health medications administered?

The most common way to administer these tests is with a swab of the inner cheek. The saliva is then analyzed at a lab.

Do insurance companies cover DNA tests for mental health medications?

You should ask your insurance company if this kind of DNA test is covered before you get a test. If it’s not covered, ask how much the test will cost. A test could cost $300 or more, depending on the company that provides it.

Aside from using DNA tests, what should I tell my doctor?

The most important thing is to have a conversation with your psychiatrist or physician and ask questions. Make sure you share your symptoms and what you’re struggling with, what you'd most like to see happen with treatment and what medications you’ve used before. Make sure you also tell your provider the other medicines or supplements you take, and whether you use any other substances.

Getting that full history will allow psychiatrists and physicians to make the best decisions in collaboration with you.

What are reasons a mental health medication might not work?

• You may not have been on it long enough. Try to give medications four to six weeks before deciding to stop. And make sure to tell your psychiatrist or physician before stopping.
• The dose may not be high enough. Providers usually start low to avoid side effects and gradually increase the dosage.
• Other medications, supplements or substances might be interfering with the medication.
• You may not be taking the medicine regularly enough or you’re missing doses.

What are some common side effects of mental health medications?

• Nausea or upset stomach
• Headaches
• Sedation
• Sexual side effects
• Weight gain
• Shakiness/tremors
• Suicidal thoughts, especially for those who are 25 or younger