Psychiatric Medications and Your DNA

What Decode+ Shows You

Decode+ analyzes your CYP2C19 genotype and maps it against CPIC clinical guidelines for psychiatric medications — CYP2C19 is the primary metabolic pathway for several commonly prescribed SSRIs and tricyclic antidepressants. Many other psychiatric medications also depend on CYP2D6, but CYP2D6 needs a specialized caller that a consumer genotyping array does not provide. Rather than guess, Decode+ tells you honestly when a medication depends on CYP2D6 and cannot be resolved from your data.

Your results identify your CYP2C19 metabolizer phenotype and flag specific medications where your genetics may affect drug metabolism, exposure, or side-effect risk — including an honest flag for CYP2D6-dependent medications that need specialized testing. Results are organized by condition (depression & anxiety, ADHD) and summarized so you can discuss them with your provider.

Medications Covered

Decode+ covers psychiatric medications with CPIC-level evidence for CYP2C19 or CYP2D6 drug-gene interactions. For CYP2C19- dependent medications, Decode+ calls your genotype directly; for CYP2D6-dependent medications, Decode+ tells you honestly that the gene can't be called from array data. Medications include:

• SSRIs: escitalopram (Lexapro), sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox)
• SNRIs: venlafaxine (Effexor)
• Tricyclic antidepressants: amitriptyline, nortriptyline, clomipramine, imipramine, desipramine
• ADHD medications: atomoxetine (Strattera)
• Antipsychotics: clozapine (Clozaril), flupentixol (Fluanxol)

This list represents medications with current CPIC guideline evidence. Coverage may expand as new guidelines are published. For a broader view of CYP2D6-metabolized antidepressants, see our CYP2D6 and antidepressants guide.

How It Works

1. Upload your DNA data from 23andMe, AncestryDNA, MyHeritage, or FamilyTreeDNA.
2. Your raw data is analyzed to extract CYP2C19 variants and assign star alleles, diplotypes, and metabolizer phenotypes. CYP2D6 cannot be reliably called from array data, so it is not included in this step — medications depending on it are flagged separately.
3. Results are mapped to CPIC guidelines for each psychiatric medication, identifying interactions where your genotype may affect drug metabolism.
4. Your results appear in Decode+ with a priority dashboard, condition-based groupings, and a decision table you can review and discuss with your provider.

For details on the analysis pipeline, see our methodology page or read about how pharmacogenomic testing works.

Who This Is For

• People currently taking or considering antidepressants, ADHD medications, or antipsychotics who want to understand how their genetics may affect drug metabolism.
• People who have experienced side effects or lack of response with psychiatric medications and want to explore whether pharmacogenomics could provide useful context for their prescriber.
• Anyone with 23andMe, AncestryDNA, or other consumer DNA data who wants to extract pharmacogenomic insights from raw data they already have.

The Genes Behind Your Results

CYP2C19 is the pharmacogene Decode+ can reliably call from your raw data. CYP2D6 is also clinically important for psychiatric medications, but it requires specialized testing Decode+ doesn't perform — here's the science behind both:

• The CYP2D6 gene — Metabolizes approximately 25% of all prescribed medications, including many antidepressants (fluoxetine, paroxetine, venlafaxine, nortriptyline), antipsychotics (clozapine, flupentixol), and atomoxetine for ADHD. CYP2D6 needs a specialized caller that a consumer genotyping array does not provide, so Decode+ does not call your CYP2D6 status — affected medications are flagged as such rather than guessed.
• The CYP2C19 gene — The primary metabolic pathway for escitalopram, sertraline, citalopram, and several tricyclic antidepressants including amitriptyline and clomipramine. Decode+ calls your CYP2C19 genotype directly from your raw data.

Your metabolizer status for CYP2C19 determines whether CPIC guidelines flag any CYP2C19-dependent psychiatric medications for potential dose adjustments or alternative therapy considerations.

What's Inside Decode+

• Risk snapshot: Summary of significant and moderate findings across your psychiatric medication profile.
• Condition-based groupings: Medications organized by depression & anxiety, ADHD, and other psychiatric indications.
• Decision table: Each flagged medication with gene, guideline action, and CPIC evidence level.
• Detailed gene findings: Your CYP2C19 diplotype, activity score, and phenotype classification — plus an honest flag on any CYP2D6-dependent medications you take.
• Provider-ready summary: A clear overview of your findings to discuss with your healthcare provider.

Limitations

• Decode+ analyzes CYP2C19 only. CYP2D6 also affects many psychiatric medications, but it cannot be reliably called from consumer genotyping data — Decode+ flags CYP2D6-dependent medications rather than guess at a result. Other genes and non-genetic factors also influence psychiatric medication response.
• Your key gene CYP2D6 cannot be called from a genotyping array: it needs a specialized caller to resolve structural and copy-number variation that consumer arrays don't capture.
• Pharmacogenomic results do not predict whether a medication will reduce your symptoms. They indicate how your genetics may affect drug metabolism.
• This is not medical advice. All medication decisions should be made with your healthcare provider. See our full limitations page.

Learn More

• Pharmacogenomic Testing for Depression — What your DNA can and cannot tell you about antidepressant response.
• CYP2D6 and Antidepressants — Which antidepressants are metabolized by CYP2D6 and what that means.
• CYP2C19 and SSRI Metabolism — Why CYP2C19 matters for escitalopram, sertraline, and other SSRIs.
• Pharmacogenomics for ADHD — What genetic testing can and cannot tell you about ADHD medications.
• Pharmacogenomics for Anxiety — What genetic testing reveals about anxiety medication metabolism.
• What Is Pharmacogenomics? — An introduction to the science behind your results.
• What To Do With Your 23andMe Raw Data — How to extract pharmacogenomic insights from DNA data you already have.
• Nutrition & Methylation — How your DNA affects folate, B12, vitamin D, and other nutrient metabolism.

Frequently Asked Questions