title: Utility of integrated pharmacogenomic testing to support the treatment of major depressive disorder in a psychiatric outpatient setting.
abstract: OBJECTIVE
  The objective was to evaluate the potential benefit of an integrated, five-gene pharmacogenomic test and interpretive report (GeneSight) for the management of psychotropic medications used to treat major depression in an outpatient psychiatric practice.
  
  
  METHODS
  The open-label study was divided into two groups. In the first (unguided) group (n = 113), pharmacogenomic information was not shared until all participants completed the study. In the second (guided) group (n = 114), the pharmacogenomic report was provided to physicians for clinical use. Three depression ratings, the 17-item Hamilton Rating Scale for Depression (HAMD-17), the Quick Inventory of Depressive Symptomatology - Clinician Rated (QIDS-C16), and the Patient Health Questionnaire (PHQ-9), were collected at baseline, and at 2, 4, and 8 weeks.
  
  
  RESULTS
  The guided group experienced greater percent improvement in depression scores from baseline on all three depression instruments (HAMD-17, P < 0.0001; QIDS-C16, P < 0.0001; PHQ-9, P < 0.0001) compared with the unguided group. Eight-week response rates were higher in the guided group than in the unguided group on all three measurements (HAMD-17, P = 0.03; QIDS-C16, P = 0.005; PHQ-9, P = 0.01). Eight-week QIDS-C16 remission rates were higher in the guided group (P = 0.03). Participants in the unguided group who at baseline were prescribed a medication that was most discordant with their genotype experienced the least improvement compared with other unguided participants (HAMD-17, P = 0.007). Participants in the guided group and on a baseline medication most discordant with their genotype showed the greatest improvement compared with the unguided cohort participants (HAMD-17, P = 0.01).
  
  
  CONCLUSIONS
  These findings replicate previous studies and demonstrate significantly improved depression outcomes with use of GeneSight, an integrated, multigenetic pharmacogenomic testing platform.
authors.affiliation: aMayo Clinic Department of Psychiatry and Psychology bDepartment of Information Technology cDepartment of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota dFranciscan Skemp Behavioral Health, La Crosse, Wisconsin eWinner Psychiatry, Boulder, Colorado fAssureRx Health, Mason, Ohio, USA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Hall-Flavin
authors.forename: Joel G
authors.initials: JG
authors.lastname: Winner
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Allen
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Carhart
authors.forename: Brian
authors.initials: B
authors.lastname: Proctor
authors.forename: Karen A
authors.initials: KA
authors.lastname: Snyder
authors.forename: Maureen S
authors.initials: MS
authors.lastname: Drews
authors.forename: Linda L
authors.initials: LL
authors.lastname: Eisterhold
authors.forename: Jennifer
authors.initials: J
authors.lastname: Geske
authors.forename: David A
authors.initials: DA
authors.lastname: Mrazek
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D015283:Citalopram / Q000627:therapeutic use; D015331:Cohort Studies; D019388:Cytochrome P-450 CYP1A2 / Q000235:genetics; D065731:Cytochrome P-450 CYP2C19; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010597:Pharmacogenetics / Q000379:methods*; D011569:Psychiatric Status Rating Scales / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D019388:Cytochrome P-450 CYP1A2; D065731:Cytochrome P-450 CYP2C19; D019389:Cytochrome P-450 CYP2D6