Increasing access to mental health

While there may be benefits to living in the rural areas of Wyoming, including near immediate access to scenic mountain ranges and rushing rivers, a setback is a lack of mental health services. In the Platte Valley, there is access to counseling but access to someone who can prescribe medication is limited by transportation. Even then, patient and provider must work for months to determine what medication would work best in response to depression, anxiety or other mental health needs.

The Platte Valley Clinic has just introduced a service that may make that process a little easier. GeneSight Psychotropic, or GeneSight, is a genetic test that analyzes a patient’s DNA to aid their primary care provider or mental health provider in prescribing medication. Ruby Ayers, who currently is employed as a nurse practitioner at Platte Valley Clinic, first encountered GeneSight while in Missouri.

“I was doing my nurse practitioner clinicals in Springfield, Missouri area working in a federally qualified healthcare facility for pediatrics and, in the pediatric population specifically, it is important that you take into consideration how these medications can adversely affect that particular population,” said Ayers.

To analyze the DNA of a patient, providers do a mucosal swab in which they scrape the inside of the patient’s cheek. The sample is then sent to GeneSight where testing is done on the genetic makeup of the patient and is analyzed.

“They analyze that DNA according to what medications would best suit that particular patient. There’s a lot of things in the system—livers, kidneys and things like that—that work on how drugs interact with the body and there are some of those that can adversely affect the body depending on how that patient processes those medications,” Ayers said. “It takes that into consideration and it looks at these medications and determines which ones would be most beneficial based on the DNA profile. So this is literally like 21st century medication; using genetics to tailor medications to patients.”

By providing an analysis of a patient’s genetic makeup, a primary care provider in a rural area such as the Platte Valley can prescribe medication that will have the least adverse effects.

“That way, we’re not just upping medications when it doesn't work, changing medications and just basically playing a Russian Roulette to find out which medication is actually going to work for the patient. It allows us to try and get it on the first try,” said Ayers.

While GeneSight is supposed to help reduce the guessing game when it comes to finding the right medication for depression or anxiety, there is still the chance of a medication increasing suicidal ideation in a patient.

“The one thing I want to explain, and this is where people seem to really have a hard time grasping this, it has been known for years that when you start a medication … it increases the risk for suicidal ideation,” Ayers said.

Ayers added that it is not the medication increasing suicidal ideation, but that the medication is enhancing the neurotransmitters which can provide the mental energy not present when a patient is in a severe depression.

“I’m not going to say that there’s not that possibility with this, but it decreases it drastically with it being an issue,” said Ayers.

Most insurance should cover a GeneSight test if it can be proven to be medically necessary and the cost of such a test shouldn’t exceed $330. If it does, according to Ayers, GeneSight will call the patient and inform them that their insurance won’t cover the test before asking if the patient still wants their DNA analyzed.

“I just think that this is a really good avenue for primary care providers to be able to help patients with mental health, instead of trying to drive four or five hours and waiting six months to see a mental health professional,” Ayers said.

Boxes containing the GeneSight tests are currently at the Platte Valley Clinic. Those interested in having a genetic analysis can schedule an appointment by calling 307-326-3169.