Get the Rxight® Genetic Test to Know Your Risks
Psychiatric medications (often called “psychotropics”) are routinely used to treat a variety of psychiatric disorders – ranging from ADHD (attention deficit hyperactive disorder) and depression to bipolar disorder and anxiety to schizophrenia – Psychiatric medications are generally jused as an adjunct to psychotherapy.
It is estimated that 17 percent (some 80 million people) in the United States are taking some form of psychiatric medication (Scientific American, “1 in 6 Americans Takes a Psychiatric Drug,” Dec 13 2016) According to the article, an earlier government report, from 2011, found that just over 10% of adults are taking prescription drugs for “problems with emotions, nerves or mental health,” published in the journal JAMA Internal Medicine.
While the potential benefits of psychotropic medications have been demonstrated in research and clinical practice for decades, patients are cautioned to remain vigilant of the many side effects of psychiatric medications.
This article presents a detailed summary of the major types of mental health medications and their associated risks for side effects as reported by the U.S. Food and Drug Administration (FDA) and the National Institute of Mental Health (NIMH) and an overview of the benefits of the Rxight® genetic test for psychiatric medications in identifying your unique genetically determined risk for developing side effects or non-response to dozens of these psychiatric medications along with hundreds of other medications across 50 pharmacological classes.
Antidepressant Side Effects
What are antidepressants?
Antidepressants are commonly used to treat depressive disorders. They also are used for other conditions, such as pain, anxiety and insomnia. Although antidepressants are not FDA-approved specifically to treat ADHD, they are sometimes used “off-label” for ADHD treatment.
The most commonly prescribed types of antidepressants today are called . Examples of SSRIs include:
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Escitalopram (Lexapro)
- Citalopram (Celexa)
- Sertraline (Zoloft)
Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs) .These are chemically similar to SSRIs and include and duloxetine (Cymbalta) and venlafaxine (Effexor).
Another antidepressant that is commonly used is bupropion – a third sub-class of antidepressant which acts differently than either SSRIs or SNRIs. Bupropion is also used to treat seasonal affective disorder (SAD) and for smoking cessation treatment.
SSRIs, SNRIs, and bupropion are commonly used today because they do not cause as many side effects as the older (“first generation”) classes of antidepressants, and moreover are effective in treating a broader range of depressive and anxiety disorders.
Older antidepressant medications include tricyclic antidepressants, tetracyclic antidepressants, and monoamine oxidase inhibitors (MAOIs). These are less commonly prescribed since the development of the newer generation antidepressants.
What are the possible side effects of antidepressants?
Some antidepressants may cause more side effects than others. The most common side effects listed by the FDA include:
- Sexual problems (impotence or inability to orgasm)
- Nausea and vomiting
- Weight gain
- Sleepiness or fatigue
In 2004, the FDA ordered a “black box” label – the most serious warning it issues – on all antidepressants to caution of psychiatric drugs’ increasing suicide risk in children and adolescents. In 2006, the FDA increased the age to include young adults up to age of 25. (FDA, Revision to Product Labeling, 2004)
Call your doctor immediately if you have any of the following symptoms, especially if they are new, worsening, or worry you (U.S. Food and Drug Administration, 2011):
- Suicidal thoughts or actions
- New or worsening depression
- New or worsening anxiety
- Feeling restless or agitated or
- Panic attacks
- New or worsening irritability
- Acting aggressively, being angry, or violent
- Acting on dangerous impulses
- An increase in activity and talking (mania)
Additionally, drug interactions can occur. Specifically, combining the newer SSRI or SNRI antidepressants with one of the commonly-used “triptan” medications for treating migraines can cause a life-threatening condition called “serotonin syndrome.” Serotonin syndrome is marked by agitation, hallucinations, high temperature, or unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well.
Antidepressants may cause other side effects that were not included in this list, as determined by individual genetics and ability to metabolize the drug in the liver.
How do patients respond to antidepressants?
Some people respond better to some antidepressant medications than to others. It is critical to know that some people may not feel better with the first medicine they try. Additionally, sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return.
These inter-individual differences are based in genetics, and the Rxight® genetic test will indicate which antidepressants may not work for you right from the start instead of having to go through trial and error with your doctor With Rxight results, you your doctor can work together to find the best and most effective antidepressant treatment tailored to your unique genetics.
Antipsychotic Side Effects
What are antipsychotics?
Antipsychotic medicines are primarily used to manage psychosis, a condition that affects the mind. Psychosis is characterized by some loss of contact with reality, often including or hallucinations (hearing or seeing things that are not really there), or delusions (false, fixed beliefs). It can also be a symptom of a physical condition such as drug abuse or a mental disorder such as schizophrenia, very severe depression (also known as “psychotic depression”), or bipolar disorder.
Antipsychotic medications are frequently used in combination with other drugs to treat delirium, dementia, and mental health conditions, including:
- Post-traumatic Stress Disorder (PTSD)
- Attention-Deficit Hyperactivity Disorder (ADHD)
- Eating Disorders
- Generalized Anxiety Disorder
- Post-traumatic Stress Disorder (PTSD)
- Obsessive Compulsive Disorder (OCD)
The older antipsychotic medications are conventionally referred to as “typical” antipsychotics or “neuroleptics”. Some of the common typical antipsychotics include:
Second generation antipsychotic medications are also called “atypical” antipsychotics. Some of the most common atypical antipsychotics are:
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
- Paliperidone (Invega)
- Lurasidone (Latuda)
- Brexpiprazole (Rexulti)
According to a 2013 research review by the Agency for Healthcare Research and Quality , typical and atypical antipsychotics both work to treat of bipolar disorder (preventing mania) and symptoms of schizophrenia Additionally, some atypical antipsychotics have wider applications and are used for treating bipolar depression or general depression.
What are the possible side effects of antipsychotics?
Antipsychotics are known to have a large number of side effects (also called adverse events) and risks, including potentially fatal complications.
The FDA lists the following side effects of antipsychotic medicines:
- Uncontrollable movements, such as tics and tremors (the risk is higher with typical antipsychotic medicines)
- Seizures Drowsiness
- Blurred vision
- Low blood pressure
- Weight gain (the risk is higher with some atypical antipsychotic medicines)
- Dry mouth
- A low number of white blood cells, which fight infections
Typical antipsychotic medications can also cause additional side effects related to physical movement, such as:
- Muscle spasms
Long-term use of antipsychotic medications may lead to a condition called tardive dyskinesia (TD). Tardive dyskinesia causes uncontrolled muscle movements, commonly around the mouth. TD can range from mild to very severe, and in some people, the problem cannot be cured and becomes disfiguring.
Avoid the Risk of Antipsychotic Side Effects with Rxight®
The Rxight® medication panel includes 18 popular antipsychotics on the market. Because the potential side effects of both typical and atypical antipsychotics can be very serious and potentially fatal, knowing your risks ahead of time with Rxight® can be an invaluable test for you and your prescriber.
Mood Stabilizer Side Effects
What are mood stabilizers?
Mood stabilizers work by decreasing abnormal brain activity. They are used mainly to treat bipolar disorder and the mood swings associated with other mental conditions including:
- Depression (usually in conjunction with an antidepressant)
- Disorders of impulse control
- Schizoaffective Disorder
Anticonvulsant (anti-seizure) medications are most frequently used as mood stabilizers. They were originally developed for treatment of seizures, but they were found to help control mood swings as well. One anticonvulsant commonly used as a mood stabilizer especially in patients with symptoms of both mania and depression, or those with rapid-cycling bipolar disorder, is valproic acid (sold as Depakote). Anticonvulsants used as mood stabilizers include:
Lithium is a non-anticonvulsant mood stabilizer approved for the treatment of mania and the maintenance treatment of bipolar disorder.
What are the potential side effects of mood stabilizers?
Mood stabilizers can cause several side effects, some of which may be serious, especially at high dosages. These side effects include:
- Potentially fatal rash (Stevens-Johnson Syndrome)
- Extreme thirst
- Nausea and vomiting
- Fast, slow, or irregular heartbeat
- Slurred speech
- Changes in vision
- Loss of coordination
Mood stabilizers may cause other side effects that are not included in this list. Your unique reaction to anticonvulsants is based in genetics, and the Rxight® genetic test will indicate which mood stabilizer not work for you may right from the start instead of having to go through trial and error with your doctor – a process which can be expensive, lengthy and dangerous. With Rxight® results, you your doctor can work together to find the best and most effective antidepressant treatment tailored to your genotype, preferably before treatment begins.
Anti-Anxiety Medication Side Effects
What are anti-anxiety medications?
Anti-anxiety medications (also called “anxiolytics”) work by reducing the symptoms of anxiety, such as that seen in panic attacks, or extreme worry and fear. The most commonly prescribed anti-anxiety medications are called “benzodiazepines.” Benzodiazepines are most frequently used to treat a condition called generalized anxiety disorder, while in cases of social phobia (social anxiety disorder) or panic disorder (panic attacks). Benzodiazepines are usually second-line treatments, behind antidepressants such as SSRIS.
Benzodiazepines used to treat anxiety disorders – all of which are tested in the Rxight® panel – include:
- Clonazepam (Klonopin)
- Alprazolam (Xanax)
- Lorazepam (Ativan)
- Diazepam (Valium)
- Oxazepam (Serax)
- Clobazam (Onfi)
Short-acting benzodiazepines such as Lorazepam and another class of medication known as beta-blockers are used to treat non-persistent symptoms of anxiety. Beta-blockers are used primarily to manage physical symptoms of anxiety (e.g., shaking, rapid heartrate, and sweating).
Buspirone (which is chemically unrelated to the benzodiazepine family) is sometimes indicated for the long-term treatment of chronic anxiety. It is not effective to use on an “as-needed” basis like the benzodiazepines.
How common is addiction to benzodiazepines?
One of the serious risks of anti-anxiety medications is that you can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need increasingly higher doses to get the same effect. There is a serious risk of addiction and dependence. To avoid these problems, doctors usually prescribe benzodiazepines for short periods, particularly in the elderly (NIMH, “Despite Risks, Benzodiazepine Use Highest in Older People”), and people with addiction tendencies. If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms or their anxiety may return.
What are the possible side effects of anti-anxiety medications?
Like other medications, anti-anxiety medications may cause side effects, many of which are serious. The most common side effects of benzodiazepines are sleepiness and dizziness. Other possible side effects include:
- Blurred vision
Tell your doctor immediately if any of these symptoms are severe or do not go away:
- Difficulty thinking or remembering
- Increased saliva
- Problems with coordination
- Blurred vision
If you experience any of the symptoms below, call your doctor immediately:
- Swelling of the eyes, face, lips, tongue, or throat
- Difficulty breathing or swallowing
- Yellowing of the skin or eyes (jaundice)
- Difficulty speaking
- Difficulty breathing
Common side effects of beta-blockers include:
- Cold hands
Stimulant Side Effects
What are Stimulants?
Stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. Stimulant medications are generally prescribed to treat individuals diagnosed with ADHD (attention-deficit hyperactivity disorder). People with ADHD who take prescription stimulants describe a calming and “focusing” effect from the medication. This is due to its effects on the brain chemical dopamine.
Stimulants used to treat ADHD – all of which are analyzed in the Rxight® DNA test – include:
- Methylphenidate (Ritalin, Concerta)
- Amphetamine (Adderall)
- Dextroamphetamine (Dexedrine)
- Dexmethylphenidate (Focalin)
- Lisdexamfetamine Dimesylate (Vyvanse)
In 2002, the FDA approved non-stimulant medication atomoxetine (Strattera) for use as a treatment for ADHD. Additional non-stimulant antihypertensive medications, clonidine and guanfacine, are also approved for treatment of ADHD.
In addition to treating ADHD, stimulants are prescribed to treat other health conditions, including narcolepsy, and occasionally depression.
What are the possible side effects of stimulants?
Stimulants may cause side effects, most of which are relatively minor and disappear when dosage levels are lowered. The most common side effects include:
- Loss of appetite
- Stomach pain
Less common side effects include:
- Motor tics or verbal tics
- Personality changes
What are serious side effects of stimulant medications?
While side effects of stimulant medications tend to be minimal, patients and parents of patients are cautioned that serious adverse effects may occur, as reported by the FDA Drug Safety Communication in 2013. Also see
FDA Warns of Psychiatric Adverse Events from ADHD Medications.
- Sudden death in patients who have heart problems or heart defects
- Myocardial infarction (heart attack)
- Increased blood pressure and heart rate
Mental (Psychiatric) problems:
- Behavior and thought problems
- New or worse aggressive behavior or hostility
- New or worse bipolar illness
- New psychotic symptoms (or new manic symptoms)
- Physical or psychological dependence
For additional details on the FDA warnings and manufacturer labeling for medications covered in the Rxight® panel, please refer to our list of medications covered.
About Rxight® Pharmacogenetic Testing
The Rxight® genetic test analyzes your risks based on your unique genetic makeup through a process called “SNP genotyping.” The report which will be shared with you in a personal consultation with a pharmacist. The report “red-flags” medications which may cause you to have issues, or conversely highlight medications which may not be effective for you.
Rxight® is based on pharmacogenetics — the study of how genes affect a person’s response to medicines. Our panel of over 200 clinically significant medications includes dozens of commonly prescribed psychiatric medications, including antidepressants across five sub-classes, mood stabilizers used in bipolar disorder and schizoaffective disorder, antipsychotics, ADHD medications (stimulant and non-stimulant), and anti-anxiety medications.
Based on how well you metabolize those particular medications, which is determined by your genes that encode liver enzymes that break down drugs, you will be at risk for developing side effects or the medication not working well or at all. With the results of the Rxight® test you and your prescriber can find the right medication for you, preferably before treatment begins.