Pharmacogenetic testing now available

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As part of our commitment to excellence and innovation, the Center of Excellence in Co-Occurring Medicine now offers pharmacogenetic testing. The DNA collection process is easy and non-invasive; a simple cheek swab provides the genetic material for laboratory testing.

At the Center of Excellence, we use pharmacogenetic testing:

  • For patients who would like to determine the medications that their bodies would most likely tolerate well.
  • For patients who have frequently experienced side effects or adverse reactions to medications in the past and would like to find alternative medications.
  • For patients who feel they are too sensitive to medications or for those who feel they need higher than recommended doses of medications to attain relief from their symptoms. For these patients, pharmacogenetic testing can help determine the rate of metabolism for specific medications by examining the genetic variants that determine the individual functioning of key liver enzymes involved in processing these medications.
  • To rule out methylenetetrahydrofolate reductase (MTHFR) deficiency in patients who have been suffering from treatment-resistant depression, irritability, mood instability, anxiety, and/or poor concentration. MTHFR deficiency may lead to a decreased ability to produce certain neurotransmitters that can help alleviate these discomforts and help medications work properly.

The Center of Excellence offers pharmacogenetic testing through the MD Labs Rxight service. Based on each patient’s unique genetic profile, test results indicate how a patient is likely to metabolize medications used to treat mental health concerns such as anxiety, depression, mood swings, poor concentration, psychosis, and dementia. Testing through Rxight also provides patients with a list of prescription and over-the-counter medications they are likely to best and least tolerate for a broad range of medical conditions, including high cholesterol, hypertension, diabetes, pain (including fibromyalgia), autoimmune diseases, clotting disorders, and seizure disorders. See the complete list of medications tested and conditions covered.

It’s important to note that pharmacogenetic testing is simply an innovative tool to inform patient care; it does not replace the provider’s role in determining the best treatment plan based on each individual’s unique needs.

For more information about pharmacogenetic testing at the Center of Excellence, please call us at (503) 832-0945. To learn more about our team and services, visit our website.

Learn more about the gene panel for the Rxight test.

ADHD in Children, Adults, and Seniors: A Deeper Look (Part 3 of 3)

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Treatment for ADHD

Medical Treatments

Numerous medications are available to treat ADHD, including antidepressants (especially those in the tricyclic family); stimulants in the methylphenidate and amphetamine family; medications traditionally used to lower blood pressure, such as guanfacine and clonidine; and “Noradrenergic reuptake inhibitors” such as atomoxetine. These medications can be helpful in abating symptoms for the right patient with the right set of symptoms. It is important to note that some medications work best for certain subtypes of ADHD, and all medications are associated with risks and possible benefits. Since not all medications are safe or effective for every individual, it is important to complete a thorough evaluation with a psychiatrist or psychiatric nurse practitioner before starting ADHD treatment.

ADHD medications have different properties and mechanisms of action, with some modulating dopamine (DA) and/or norepinephrine (NE) release and absorption in some parts of the brain much more aggressively than others. The range of available medications comes in handy, as not all individuals with ADHD present in the same way or experience the same level of neurotransmitter deregulation. Thus, affected individuals benefit most when they are prescribed the right medications for their individual needs. Finding the right dose is also essential, as inattention, impulsivity, and inefficient information processing can be caused not only by too little DA and/or NE in the prefrontal cortex, but also from too much. I call this the “goldilocks syndrome.” This means that giving someone an ADHD medication that is too strong or a dose that is too high can worsen symptoms or cause them to feel devoid of energy and motivation. Read more

ADHD in Children, Adults, and Seniors: A Deeper Look (Part 2 of 3)

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Neurobiology of ADHD and Comorbidities

Neurobiological research indicates it is reasonable to consider ADHD as a condition that falls under the “reward deficiency syndrome” (RDS) diagnostic umbrella (Blum et al. 2008), as symptoms of poor concentration stem from the brain’s inability to release sufficient amounts of dopamine (DA) in areas of the frontal lobes and limbic system to provide a feeling of reward when applying and/or maintaining focus on tasks at hand.

DA is the neurotransmitter most linked to attention and the ability to experience pleasurable emotions and sensations; It allows for general feelings of wellbeing, tempering of unpleasant emotions, good concentration, and optimal thought organization. For this reason, certain individuals with ADHD are more likely to experience depression. They may also develop thrill-seeking behaviors and engage in risky activities that result in an increased release of dopamine, such as high-risk sports, gambling, hypersexual behaviors, excessive internet video gaming, aggressive behavior, drug use, excessive shopping, and binge eating. Since DA is fundamental to producing pleasure and it impacts the activity of natural opioids in the brain, it also helps decrease feelings of uneasiness and drug withdrawal. People with RDS are therefore at higher risk of addiction to recreational or illicit drugs, as they may have a harder time stopping them (Blum et al. 2008). Read more

ADHD in Children, Adults, and Seniors: A Deeper Look (Part 1 of 3)

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You are probably familiar with the term ADHD (Attention Deficit and Hyperactivity Disorder). But not everyone with ADHD is hyperactive. In fact, ADHD can be a misleading term. Depending on which parts of the brain are affected, ADHD is currently diagnosed in three different forms:

  1. The predominantly inattentive type, commonly referred to as ADD (Attention Deficit Disorder).
  2. The predominantly hyperactive-impulsive type.
  3. The combined inattentive and hyperactive/impulsive type.

ADHD in a Nutshell

ADHD is a condition that can affect children, adults and seniors. It is theorized to be anchored in a hypersensitive nature to exterior stimuli and an inability to efficiently differentiate between irrelevant and essential stimuli, which is necessary to complete tasks and engage with others in a relevant and productive manner (Blum et al. 2008). The effects of this faulty filtering system can usually be narrowed down to four aspects of cognitive ability:

  1. Selective attention
  2. Sustained attention
  3. Impulse control
  4. Psychomotor activity.

Read more