If you’ve ever been on a psychiatric medication, you know the routine. You start, six weeks later you decide it isn’t working, or the side effects are too much, so you stop, wait for it to clear out of your system and try something different. Repeat. Sometimes for years.
This cycle is not random and there is a reason it happens so often.
Two people can be given the same diagnosis, see a provider in the same specialty type and receive the same type of prescription. One of them improves. The other doesn’t, or feels worse, gains weight or feels completely flat.
It appears that for some people the med works and in others it does not – this is correct. What is less clear than the fact of how this happens, really, is why it does: a larger part of that answer exists in your DNA.
Your liver decides a lot more than people realize.
If you are taking a psychiatric drug, your liver metabolizes the drug through enzymes.
What determines the speed and efficiency of that process is how well endowed you are in the versions of those genes that you inherited from your parents.
And this field of study of how genetics influences response to drugs is known as pharmacogenomics. It sounds technical, but really it’s pretty simple: you metabolize drugs a certain way in your body (which is NOT the same as everybody else).
Some people are fast metabolizers. Unfortunately, the drug is metabolised and eliminated before it can accumulate to a therapeutically active concentration. Looks like the drug is not working. The dose keeps going up. Nothing happens.
Some people are slow metabolizers. Standard doses accumulate more than expected. Side effects hit hard at amounts that most people can tolerate. They get labeled as “sensitive to medications” when really their liver is just processing things differently than the dosing guidelines assumed.
Neither of these is a flaw. It is just biology. But for a long time, prescribers had no way to know which category you were in without putting you through the trial-and-error process to find out.
A cheek swab can tell you what years of trying medications might not.
Pharmacogenomic testing is a simple swab, similar to an ancestry test. The sample goes to a lab and comes back as a report flagging how your specific genes interact with specific medications. Which ones are your body likely to clear too quickly? Which ones might build up to uncomfortable levels? Which ones are probably going to behave the way they are supposed to?
It does not tell you what you have or what will definitely work. But it gives a prescriber real information to work from instead of just statistics and educated guesses.
In psychiatry, the enzymes that matter most go by names like CYP2D6 and CYP2C19. They metabolize a wide range of antidepressants, antipsychotics, and ADHD medications. Knowing your status for those enzymes can:
- Explain why a medication that works well for someone else in your family did nothing for you, or hit you much harder
- Flag medications where your metabolizer status puts you at a higher risk of side effects at standard doses
- Help a provider prioritize which medications to try first based on actual biology rather than general guidelines
Catch certain genetic markers that are linked to serious reactions with specific mood stabilizers before you ever take them.
For some people, getting this test is the first time their medication history actually makes sense. Not that the treatments failed. That their body was never set up to use them the way standard dosing assumed.
Who does this tend to help most?
If you tried one medication and it worked and you’re fine, there is no issue. However, for a group of people, this test may revolutionise the dialogue.
- You’ve been through a dozen drugs and neither one worked, or drug side effects were bad enough each time that you could not tolerate them
- You have experienced emotional reactions that didn’t quite seem to match the event
- You have a family history of abnormal responses to medicines, someone in your family needed much higher or lower doses than usually expected
- You are beginning psychiatry treatment and want to be as intentional as is possible about what you try first instead of proceeding down a checklist
Being honest about what it cannot do.
The marketing around pharmacogenomic testing sometimes gets ahead of the science. A clean genetic report does not mean a medication will work. It means your body is better positioned to process it. Your diagnosis, your history, your sleep, your stress, your therapy, your life, all of that still matters enormously. Genes are one variable, not the whole answer.
Insurance coverage also varies. Some plans cover it readily, others do not. Worth checking before expecting it to be included.
And the science itself is still developing. Some gene-drug interactions have decades of evidence behind them. Others are newer and less certain. A good provider will tell you the difference rather than presenting every finding with the same level of confidence.
What this looks like in practice.
The point of testing is not to hand someone a printout and call it a day. The value is in how the results get used in an actual clinical conversation.
At Trained Mind Psychiatry, the approach has always been that your care should reflect who you specifically are, not a standard protocol built around population averages.
Pharmacogenomic data fit into that naturally. When your provider knows how your liver handles certain drug classes, medication decisions stop being a list to work through and start being something more targeted. Fewer wasted months. Fewer side effects from the wrong fit. A clearer picture of what the options actually are and why.
That kind of specificity is what it means actually to personalize care rather than just saying the word.
Tired of guessing? There is a better starting point.
We work with people throughout New Jersey who are done with the trial-and-error approach and want care that actually accounts for how they are built. Free consultations available. All appointments online.
