GeneSight Testing in Fayetteville at Sandhills Psychiatry and Mental Health

Medicine history scattered across duty stations

A typical story at our Hay Street office: a sergeant first treated for depression at a clinic in Germany, switched medicines at Fort Hood, tried a third through the VA after retirement, and still does not feel right. Records are in four places, and nobody has asked why the medicines keep missing. Sometimes the answer is the diagnosis or the dose. Sometimes part of it is genetic. GeneSight, a lab test from Myriad Genetics, looks at that genetic piece.

The short version of the science

Your liver uses enzymes to break down most psychiatric medicines, and your DNA sets how fast those enzymes run. GeneSight checks a cheek-swab sample for variants in genes like CYP2D6 and CYP2C19. If yours run slow, an ordinary dose of sertraline or paroxetine, two medicines often used for PTSD, can build up and cause side effects. If they run fast, the medicine may be cleared before it ever helps.

What the results look like

You get a report that places common medicines in three groups: use as directed, a moderate gene-drug interaction, or a significant one. A medicine in the last group is not off limits. It tells your provider to think about a different choice, a smaller starting dose, or closer follow-up.

When it is worth ordering

Testing tends to pay off for soldiers, veterans, and family members who:

• Have been through two or more medicines for PTSD, depression, or anxiety without real relief
• Got side effects on standard doses that most people do not get
• Take several other medicines for pain, sleep, or blood pressure

If you have never taken a psychiatric medicine, a standard first choice usually comes before testing.

Pain medicines matter here

Many veterans live with pain from old injuries. Codeine and tramadol only work once CYP2D6 converts them into their active form, so a slow CYP2D6 result can explain why those pills never helped. Some pain and psychiatric medicines also compete for the same enzymes. With your permission, results can go to the doctor who manages your pain.

How strong is the evidence?

Encouraging, not definitive. In the GUIDED trial, people whose providers used GeneSight results were more likely to respond to treatment and reach remission, though the study fell short on its main measure of average symptom change. Independent expert panels publish dosing advice for several antidepressants based on CYP2D6 and CYP2C19 status, and your provider follows it.

What it cannot do

It does not diagnose PTSD, depression, or anything else. It cannot promise that a specific medicine will work, and the FDA has not approved it for choosing antidepressants. Results sit next to a full psychiatric evaluation, never in place of one.

A report that moves with you

Unlike most records, this one never goes out of date, because your genes do not change. Keep a copy. After your next PCS or after retirement, hand it to your new prescriber so you do not start the trial-and-error over again.

Privacy and your command

Your results are part of your protected medical record, and we do not send them to your command without your written permission. A 2008 federal law, GINA, also bars most employers from using genetic information to make hiring, firing, or promotion decisions.

How it works here

You and your provider first decide whether results could change a real decision. If so, the swab takes about a minute during a visit. When the report arrives, your provider walks you through it and explains what changes.

When testing can wait

If you have taken just one medicine, and only for a few weeks, a full trial at a proper dose usually comes before testing. Your provider will be straight with you about whether a report is likely to change anything right now.

Getting started

Testing is part of your care with us and connects to medication management. Visit 109 Hay St in downtown Fayetteville, and become a patient to ask whether it fits your history.