Clinical Question

Is pharmacogenomic-guided antidepressant treatment beneficial in the management of major depressive disorder in adults?

Bottom Line

Pharmacogenomic testing for drug-gene interactions in adults with major depressive disorder resulted in reduced prescribing of medications with potential drug-gene interactions. However, no significant difference occurred in symptom remission rates in the gene-tested group compared with the usual care group at six months. (Level of Evidence = 1b)

Synopsis

The benefit of pharmacogenomic-guided selection of antidepressant therapy remains uncertain based on low-quality evidence. The investigators identified adults, 18 to 80 years of age, who met standard diagnostic criteria for major depressive disorder, had a history of at least one treatment episode, and were planning to switch treatments or start a new treatment episode. All patients (N = 1,944) underwent DNA collection and were randomly assigned (concealed allocation) to a group whose clinicians received the pharmaco-genomic test results within three business days or a group whose clinicians had to wait 24 weeks for results. Clinicians in the pharmacogenomic-guided group initiated treatment based on the results; the clinicians in the delayed-results group initiated treatment as usual. Individuals masked to treatment group assignment assessed the treatment results using standard scoring tools at four, eight, 12, 18, and 24 weeks. Complete follow-up occurred for 79% of patients at 24 months.