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Medication Trial and Error
Many children and adults are frustrated by the trial-and-error approach to finding the right ADHD medication for them. Some meds are effective but have intolerable side effects. Others do nothing at all. Still others work for a while only to peter out, leaving the door wide open for pesky ADHD symptoms to return. And what works for one person doesn’t necessarily work for another! Since most ADHD medications are stimulants, their side-effects can include sleep problems, anxiety, decreased appetite, and even tics.
There are numerous drugs for ADHD now, and prescribing clinicians often use a trial-and-error process to find the best fit, or at least the one that works with the fewest problems. Getting the right med for ADHD is crucial because it’s usually the best weapon there is against the condition.
Medication is considered the first line of treatment against ADHD. Other approaches, like cognitive-behavioral therapy (CBT), group support, diet, meditation, supplements, and specialized food (See my May 2015 blog: https://www.psychologytoday.com/blog/the-distracted-couple/201505/what-…), can all help with ADHD, but medication remains the single most effective intervention for ADHD for most people.
The Hope of Pharmacogenetics
So what if a product could tell you which ADHD medication works best for you? It could spare you the trial-and-error agony and get right to the best one.
Predictions like these, based on genetic factors, are the goal of a process called pharmacogenetic testing. The hope is that it will lead to better medication outcomes. The basic strategy is to match up a person’s genetic/innate factors with the medication’s properties. By doing so, the best ADHD med for a person might be found more efficiently. This could result in less trial-and-error, fewer unpleasant side effects, and maybe even better treatment compliance.
For ADHD, pharmacogenetic testing is available from GeneSight/Assurex and Harmonyx. The cost is generally less than $100, but it may not be covered by insurance (so check with your specific plan). Results provided so far seem pretty general, but then again these products are in their infancy.
A few patients have told me anecdotally that Harmonyx gave them a list of ADHD meds in three categories: those they should consider taking first (green group); those they should consider taking second (yellow group); and those they should consider taking last (red group). Somewhat helpful perhaps, but obviously not yet the pinpoint specificity of a single med or two that best matches their unique genetic profiles. If a person gets 8 or 10 medications in the green group for instance, how is s/he supposed to know which of these to try first or last?
Considerations
The scientific literature on pharmacogenetic testing for ADHD is still small and at this point cautiously optimistic. A few writers are hopeful, while others like Robert Howland (2014) say the approach is “not quite ready for prime time” in psychiatry. Pharmacogenetic testing for ADHD (and other psychiatric conditions) is still quite new. It has the potential to significantly change the medication treatment process, but it needs to be further validated and its precision improved.
If it does yield highly precise results, then some interesting ethical questions arise. For instance, how do these products interface with HIPAA guidelines? Is the genetic test information of an individual considered to be private and owned by the person, the testing company, or both? How is the privacy of individual characteristics managed so that it will not be used to discriminate? Is the information obtained worth the cost?
Feedback
If you have experience using GeneSight or Harmonyx for ADHD medication, what was it like? Would you recommend it? Please post a reply to this blog. We’d love to hear all about it!
