Dear Reader, perhaps like many of my patients who are parents, you wonder whether genetic testing might help your child become more resilient, or help them feel better about themselves and their lives, or function more effectively at school? Today, we will begin to answer those questions with our new series on the use of Genetic Testing in the evaluation and treatment of Children and Adolescents.
I am delighted to welcome once again my esteemed colleague and friend, child psychiatrist Mark A. Novitsky Jr., M.D., who will share his perspective throughout this series…
If you are like the majority of the parents who bring your child to Potomac Psychiatry for an initial intake, the idea of starting your child on medication can be intimidating. Perhaps you are being encouraged to meet with a child and adolescent psychiatrist by your child’s school staff, therapist, or pediatrician. If this has been an ongoing problem that has recently worsened, you have likely already explored individual therapy and feel that you have exhausted behavioral/therapeutic interventions. Sure, you can appreciate how any other child would benefit from medication—but, the idea of starting your child on medication… now that’s another story!
The well-informed parent that you are, you’ve probably already learned about the potential treatment options for your child’s problematic symptoms from “Dr. Google”—and possibly even read stories about all of the potential side effects that medications can cause. You’ve done your homework and though you can hide it well, it is often a toss between who is more anxious in that first session with the Child Psychiatrist, your child or you. That’s where genetic testing comes in… through the application of this pioneering biotechnology by a child psychiatrist experienced in its clinical use, we can work to minimize the trial and error that comes to finding the right treatment. All through a simple cheek swab.
How Genetic Testing Can Ease the Stress of Medicating Your Child
To help make the prospect of medicating your child a bit less stressful, Potomac Psychiatry utilizes Genomind Genetic Testing. Genetic Testing may sound a bit intimidating, but in reality, the test only takes about 30 seconds and is done right in our office. There is no blood draw, no spitting in a test tube; it consists of a Q-tip gently rolling on the inside of each of your child’s cheeks. That’s it.
After sending it off to the lab, within about a week we will have a Genetic Road Map of the genes critical to treating psychiatric conditions. These results can help guide us to the most appropriate course of treatment, but testing alone won’t give us the “magic pill”. That being said, it is an invaluable tool that gives us additional information to guide a potential treatment choice – combined with incorporating assessment of your child and all of the historical information that you’ve provided on your child in the initial interview. For years I have shared with the parents of the children I treat, “You are the world’s expert on your child”. But over the last few years, I have added the afterthought “… but DNA doesn’t lie.”
Embracing its mantra of “Whatever It Takes Medicine”, Potomac Psychiatry is a pioneer in incorporating genetic testing and integrated psychiatric treatment. We’ve used Genomind’s genetic tests for the past six years, in the evaluation and treatment of more than 1400 of our patients. And Dr. Kehr’s numerous blogs about genetic testing have been read by well over 200,000 visitors.
Not Every Child Needs Meds: How Genetic Testing Can Help Determine Alternative Routes for Feeling Better with No Medication Needed!
Though it may sound paradoxical, I have found that utilizing Genomind’s genetic tests has actually helped me to decrease the number of medications that I prescribe to children. Why? Because in addition to medication suggestions, these tests look at genes that are important in our body in regulating mood, anxiety, and focus, amongst other things. In looking at your child’s unique DNA profile we may find supplements that can either directly treat your child’s presenting symptoms, or if taken with a medication, can increase the likelihood of that medication working (thereby limiting the need of additional medications). More importantly, your child’s personal genetic road map may eliminate the likelihood of choosing an inappropriate medication that may lead to unwanted side-effects. Unfortunately, it is not uncommon for a child to present to me for a second opinion or genetic test, and I find that they have been placed on a second or third medication just to counteract the side effects from the initial choice.
In a recent case, I saw a child, Jeremy*, who had been seeing another child psychiatrist for the last year. He initially started treatment after his family noted increased irritability in the home, falling grades, withdrawal from his friends, worrisome posts on social media, and a decision to quit the school swim team (a sport that he was particularly good at and was potentially going to pay his way through college). His treating child psychiatrist had appropriately diagnosed Jeremy with depression (in children irritability is often seen as the primary symptom rather than depressed mood)—and had started him on Prozac (Fluoxetine), an SSRI antidepressant that is the most studied antidepressant in children and FDA approved for this indication. According the textbooks, this was the correct choice. For the subsequent six months, the dose was slowly increased, yet Jeremy’s symptoms got worse. Anger outbursts emerged and he had internalized that he was a bad child, often commenting that he wished he was never born. Ultimately, after he relayed to a friend that he was thinking about hurting himself, the school counselor was informed, and Jeremy was sent to a partial hospital program. While there, he was switched to an alternative SSRI antidepressant, Zoloft (Sertraline), and its dosage was slowly increased for the subsequent three months until his nausea was so great that they could not increase further. Eventually Abilify, an atypical antipsychotic medication that is often used for adjunct depression in adults, was added to his treatment. He started to gain weight on this medication, so Topamax, an antianxiety medication that potentially causes weight loss, was added. After a year of no improvement, and recent cognitive decline, he presented to my office in search of another opinion about how to help him. Understandably, the family was skeptical of the efficacy of medications altogether—and had never heard about genetic testing, but at that point was willing to try almost anything to bring back the old Jeremy.
One week later, Genomind’s genetic test yielded a crucial finding: variant alleles of SLC6A4. SLC6A4 is the gene that codes the presynaptic transmembrane protein involved in serotonin uptake in the serotonin receptor. In plain English, a backup at the serotonin receptor will result in less serotonin getting to the end target. Less serotonin can result in depression and anxiety.
The concern in this case is that the two antidepressants he was prescribed, Prozac (Fluoxetine) and Zoloft (Sertraline) work by blocking the serotonin uptake. Therefore, given his variant of two SLC6A4 short alleles, there is a higher likelihood that he would not respond to SSRI antidepressants – and moreover, that they would cause unwanted side effects.
Results of Genomind Genetic Testing suggested to avoid SSRIs and recommended several alternative options. With some skepticism, he and his parents agreed to try a third medication option, (one from a different class of antidepressants), in fear that they would “waste another year” of Jeremy’s life.
I met with Jeremy last week for a medication check – these occur infrequently now that he’s been so stable – and he caught me up to speed with his latest swimming accomplishments and a copy of his straight A report card. He’s referred a family member and several friends battling mental health concerns for genetic testing at Potomac Psychiatry, now that he’s a true believer. Seeing may be believing, but feeling better is even more impactful.
DNA 4 KIDS with Dr. Mark Novitsky
Your wish is granted! In your body, you have an incredible network of roads called nerves. These nerves put together a complicated road map that allows information to travel great lengths from one part of your body to another.
Just as you would experience on a long trip, many of the roads in our body have certain toll booths where chemicals line up to get from one place to another. If you have ever travelled on one of the busier nights of the year (think about Sunday after Thanksgiving), you know that there can be a big difference in traffic between a road that has many toll gates open and one with just a few toll booth operators that seem to take forever with collecting money.
Serotonin, one of the feel-good chemicals in your body, uses a special toll booth made by the gene SLC6A4. The very purpose of this booth is to remove extra Serotonin off the road to avoid a traffic jam. These toll booths can be a target of medications that help kids who are anxious or depressed. They are particularly helpful for kids who are born with many functioning and efficient toll gates. For the kids who have SLC6A4 toll gates that might not work as well, it would be a good idea to think of a different route besides Serotonin to help them feel good. Genetic testing through Genomind can provide this important map to help you and your doctor figure out what the best directions are for your trip to feeling good. Buckle Up, and have a safe trip on your journey to feeling better!
Related Information
- Learn about Genetic Testing
- Learn about Potomac Psychiatry
- Meet Our Doctors
- Contact Potomac Psychiatry
