Pharmacogenomic Testing to Guide Treatment of Major Depressive Disorder: A Systematic Review

Purpose of review Major depressive disorder is a prevalent psychiatric illness associated with significant morbidity, mortality, and economic burden worldwide. Despite the widespread use of antidepressants, remission rates among those treated with antidepressants remain low. Opportunities to personalize medication choices and doses and optimize clinical outcomes using pharmacogenomic testing have been evaluated. Recent findings Several prospective clinical trials and a recent meta-analysis have evaluated the impact of PGx-guided prescribing compared to treatment as usual and found no difference in clinical outcomes for patients with MDD. Summary We performed a systematic review of all prospective trials evaluating the effect of pharmacogenomic-guided prescribing on clinical outcomes of patients being treated with antidepressants for major depressive disorder. A literature search was performed using PubMed, Scopus, Web of Science, and PsychINFO databases for articles in English published from January 2010 to December 2022. Studies that did not report any patient-level outcomes were excluded. A total of 2489 studies were screened for eligibility. Full-text screening for 315 yielded 293 exclusions; thus, 22 studies were included. Sixteen of the 22 studies were randomized-controlled trials with durations varying from 90 days to 52 weeks. The findings of this systematic review suggest widespread routine pharmacogenomic testing may not yield significant changes in clinical outcomes when compared to treatment as usual. These results may or may not be generalizable to all persons taking antidepressants given guideline recommendations for pharmacogenomic-guided prescribing in patients on specific antidepressants. Future studies are warranted evaluating the utility of such testing in these subpopulations.