Antidepressant prescribing in the precision medicine era: a prescriber's primer on pharmacogenetic tools.
About half of people who take antidepressants do not respond and many experience adverse effects. These detrimental outcomes are in part a result of the impact of an individual's genetic profile on pharmacokinetics and pharmcodynamics. If known and made available to clinicians, this could improve decision-making and antidepressant therapy outcomes. This has spurred the development of numerous pharmacogenetic-based decision support tools. In this article, we provide an overview of pharmacogenetic decision support tools, with particular focus on tools relevant to antidepressants. We briefly describe the evolution and current state of antidepressant pharmacogenetic decision support tools in clinical practice, followed by the evidence-base for their use. Finally, we present a series of considerations for clinicians contemplating use of these tools and discuss the future of antidepressant pharmacogenetic decision support tools.
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia. cbousman@unimelb.edu.au.|Department of General Practice, The University of Melbourne, Parkville, VIC, Australia. cbousman@unimelb.edu.au.|Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorne, VIC, Australia. cbousman@unimelb.edu.au.|Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia. cbousman@unimelb.edu.au.
Chad A
CA
Bousman
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia.
Malcolm
M
Forbes
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia.
Mahesh
M
Jayaram
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia.|Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia.|Discipline of Psychiatry, The University of Adelaide, Adelaide, South Australia, Australia.
Harris
H
Eyre
University of Pittsburgh School of Medicine, Pittsburgh, USA.
Charles F
CF
Reynolds
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia.|Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.|Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia.
Michael
M
Berk
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia.
Malcolm
M
Hopwood
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia.
Chee
C
Ng
D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003657:Decision Making; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D010597:Pharmacogenetics; D057285:Precision Medicine / Q000706:statistics & numerical data*
D000928:Antidepressive Agents; D014150:Antipsychotic Agents
Decision support; Major depressive disorder; Pharmacogenomics; Precision medicine; Psychiatry