View Full Version : Gene analysis for helping clinicians select ADHD medications


phishphanco
07-14-13, 05:16 PM
Has anybody heard about or had any experience with "GeneSight ADHD"?

It's been around for about a year but I can't seem to find any mention of anything like it on this forum. On the one hand, it's from Mayo Clinic Doctors and it's a fairly recent thing to expect to find much, but on the other hand I'm always wary of something I can't find much information on aside from what the company has put out.

Speaking of which:
assurexhealth . com/mayo-clinic-issued-patent-covering-personalized-psychiatric-medicine-technology-commercialized-by-assurerx-health/

And from the company AssureRx (founded by the Mayo Clinic and Cincinnati Childrenís Hospital Medical Center to commercialize the technology):
"GeneSightRx ADHD analyzes variations in three genes that influence how a patient might metabolize certain medications used to treat ADHD in children and adults. Understanding a patientís unique genomic profile may help a clinician individualize a patientís medication selection and avoid side effects that often occur with these medications. The GeneSightRx ADHD analysis is based on pharmacogenomics, FDA-approved manufacturerís drug labels, published peer reviewed research, and proven pharmacology."

I have spoken to a Pediatrician who has strongly incorporated it into his medication recommendation process. I don't mean to say that it's all he uses to select and prescribe medication, but he was a big proponent of its use.

He says it's $900 and that some insurance companies will cover it. I don't want to discuss insurance companies motivations to approve or deny coverage of anything, but it is another thing that makes me wary of it. My rationale is "If this technology helped increase the accurate application of medication in the treatment of ADHD, it should reduce claims related to subsequent doctor visits to change medications." I realize this makes a number of assumptions, mainly that the cost to insurance companies would be less than the savings from reduced claims.

My main questions in deciding to use it or not are: Is the potential benefit to my child worth the $900 (if it's not covered)? Is it truly a case of "Well, it can't hurt", or is there a potential for harm in over-reliance on it because it is "scientific" compared to other decision inputs which can be viewed as more fuzzy (observation, interview, etc.)

Thanks

namazu
07-15-13, 09:04 AM
Here's an older thread on the topic:
http://www.addforums.com/forums/showthread.php?t=141110

My personal feeling is that in most typical cases, the cost of this genetic testing is not justified by the limited information these tests currently provide, but there may be (rare) individual cases in which such testing is justified. I don't think it would likely lead you terribly far astray, but I don't think it will give you much more useful information than starting one of the first-line meds at a low dose could (which would be much less expensive and probably wouldn't delay treatment further).

phishphanco
07-15-13, 02:42 PM
I don't think it would likely lead you terribly far astray, but I don't think it will give you much more useful information than starting one of the first-line meds at a low dose could (which would be much less expensive and probably wouldn't delay treatment further).Yeah, that's the direction I'm leaning at the moment, but I have no facts/evidence/experience to base that on.

Here's an older thread on the topic:
http://www.addforums.com/forums/showthread.php?t=141110Thank you for that. I read it just now. (I see now if I had wildcard searched GeneSight* I would have found it.) Aside from the digression on epigenetics, I do see at that time a few people felt it was "too early" and "too expensive".

There is also this thread (http://www.addforums.com/forums/showthread.php?t=129337) from August 2012, where you mentioned you couldn't find anything on this specific test and were wondering where they published. This AssureRx April 16, 2013 press release (http://assurexhealth.com/mayo-clinic-issued-patent-covering-personalized-psychiatric-medicine-technology-commercialized-by-assurerx-health/) was not specific to their "GeneSight ADHD" technology but it says in part "A Mayo led study published recently in Translational Psychiatry (Oct. 2012) compared GeneSight-guided prescribing versus treatment as usual prescribing in patients over an 8 week period resulting in up to a 4-fold increase in symptom improvement for guided patients."

I searched the Translational Psychiatry website (http://www.nature.com/search/executeSearch?sp-advanced=true&sp-m=0&siteCode=tp&sp-q=pharmacogenomic&sp-p=all&sp-q-9%5BTP%5D=1&sp-date-range=0&sp-s=date_descending&sp-c=25) and found the Oct 2012 study titled Using a pharmacogenomic algorithm to guide the treatment of depression (http://www.nature.com/tp/journal/v2/n10/full/tp201299a.html), but as you can see it was specific to depression not ADHD. For people who are curious what a GeneSight report looks like, that Oct 2012 study (http://www.nature.com/tp/journal/v2/n10/full/tp201299a.html) does have a picture of one of their pharmacogenomic-based interpretive reports, albeit one for psychotropic medications.

I'm mainly wondering if anyone has encountered or know anyone who has used any GeneSightRx product, or if anyone has any additional or new information regarding Pharmacogenomics (http://en.wikipedia.org/wiki/Pharmacogenomics) as it applies to ADHD medications. Thanks!

CrazyLazyGal
12-31-13, 10:13 PM
I got my results today. It listed the methylphenidate medications (Ritalin, Concerta, Focalin, etc) as the best first line treatment, with Adderall and Vyvanse listed as "use with caution".

I have tried both families of medications. The methylphenidate medications have given me unacceptable side effects or not worked. Two of them (Ritalin and Focalin) had to be stopped immediately and sent my doctor into a panic when I told him what I was experiencing. Concerta did nothing.

On the other hand, my experiences with Adderall and Vyvanse have been positive. Go figure.

dvdnvwls
12-31-13, 10:19 PM
Very very weird that Ritalin was bad and yet Concerta did nothing. It's like being allergic to glass but not allergic to windows made of glass.

TygerSan
01-01-14, 11:17 AM
Release mechanism and adjuncts can affect the way one experiences the medication. Concerta is a very slow, smooth release aside from the coating on the outside of the pill which gives a bit of a head start.

I was really disconcerted that the effects of two 10 mg pills of XR Adderall seemed to hit harder and faster than one 20 mg pill. By definition, the effects should've been identical...but they weren't. Psychological? Maybe, but no less real.

CrazyLazyGal
01-02-14, 12:49 AM
Release mechanism and adjuncts can affect the way one experiences the medication. Concerta is a very slow, smooth release aside from the coating on the outside of the pill which gives a bit of a head start.

I was really disconcerted that the effects of two 10 mg pills of XR Adderall seemed to hit harder and faster than one 20 mg pill. By definition, the effects should've been identical...but they weren't. Psychological? Maybe, but no less real.That's very strange! A while back there was a quality control problem with the 20mg pills. For a few months, my psychiatrist insisted that I take 2 pills of 10mg because of it, until the problem was solved. Maybe your pills were among the bad batches?

CrazyLazyGal
01-27-14, 07:22 PM
Very very weird that Ritalin was bad and yet Concerta did nothing. It's like being allergic to glass but not allergic to windows made of glass.It's likely due to the coating and release mechanism. I wonder if my body broke it down at all since I felt nothing good, nothing bad, just...nothing.