Abstract
Introduction
Treatment outcomes for depression and anxiety disorders remain suboptimal. Pharmacogenetic-guided
medication treatment may be one way to improve outcomes. However, feasibility of pharmacogenetic
testing in inpatient psychiatric settings has not been explored. This pilot study
investigated the feasibility of collection and potential efficacy of pharmacogenetic
testing three months after psychiatric hospitalization for severe depression and anxiety-related
symptoms.
Methods
Participants (n = 75) in this open-labeled study were inpatients on a short-term acute
care unit for severe depression and anxiety. Participants were assigned to control
and experimental conditions. The experimental group completed a psychiatric pharmacogenetic
assay while inpatient. Results were returned prior to discharge, allowing prescribers
to adjust medication regimens as clinically indicated. The control group received
pharmacogenetic results three months later. At admission and three months later, participants
completed self-report measures to address psychiatric symptoms, quality of life, and
satisfaction with the pharmacogenetic assay.
Results
Reductions on primary outcome measures were not significantly different between study
groups. The experimental group did not report significantly greater reductions than
the control group on primary study outcomes of anxiety, depression, frequency of medication
changes following discharge or on some secondary study measures. Participants in the
experimental group did report significantly greater reductions than controls on quality
of life impairment (X2 = 8.51, p=.004) after corrections for multiple comparisons.
Conclusions
This open-label pilot study provides preliminary support for the feasibility of psychiatric
pharmacogenetic testing in an inpatient setting. Future studies should investigate
psychiatric pharmacogenetic testing efficacy in larger inpatient samples and account
for medication changes resulting directly from test results.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Personalized Medicine in PsychiatryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The Economic Burden of Adults With Major Depressive Disorder in the United States (2005 and 2010).J. Clin. Psychiatry. 2015; 76: 155-162
- Prevalence and management of treatment-resistant depression.J. Clin. Psychiatry. 2007; 68: 17-25
- The Human Cost of Not Achieving Full Remission in Depression.Can. J. Psychiatry. 2004; 49
- The Impact of Treatment-Resistant Depression on Health Care Utilization and Costs.J. Clin. Psychiatry. 2002; 63: 963-971
- Quality of life across domains among individuals with treatment-resistant depression.J. Affect. Disord. 2018; 2019: 401-407https://doi.org/10.1016/j.jad.2018.09.062
- Moving towards individualized medicine with pharmacogenomics.Nature. 2004; 429: 464-468
- Contribution of Common Genetic Variants to Antidepressant Response.Biol. Psychiatry. 2013; 73: 679-682
U.S. Food & Drug Administration. Table of Pharmacogenomic Biomarkers in Drug Labeling. https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling. Published 2020. Accessed April 4, 2020.
- Pharmacogenetic-guided psychiatric intervention associated with increased adherence and cost savings.Am. J. Manag. Care. 2014; 20
- Combinatorial pharmacogenomic guidance for psychiatric medications reduces overall pharmacy costs in a 1 year prospective evaluation.Curr. Med. Res. Opin. 2015; 31: 1633-1643
- Pharmacogenetic testing among patients with mood and anxiety disorders is associated with decreased utilization and cost: A propensity-score matched study.Depress Anxiety. 2018; 35: 946-952
- Utility of integrated pharmacogenomic testing to support the treatment of major depressive disorder in a psychiatric outpatient setting:.Pharmacogenet. Genomics. 2013; 23: 535-548
- Psychiatric pharmacogenomics predicts health resource utilization of outpatients with anxiety and depression.Transl. Psychiatry. 2013; 3: e242
- Pharmacogenetic tests and depressive symptom remission: a meta-analysis of randomized controlled trials.Pharmacogenomics. 2019; 20: 37-47
- On the marketing and use of pharmacogenetic tests for psychiatric treatment.JAMA Psychiatry. 2018; 75: 769-770https://doi.org/10.1001/jamapsychiatry.2018.0834
- Pharmacogenetics in psychiatry: translating research into clinical practice.Mol. Psychiatry. 2012; 17: 760-769
- Pharmacogenomic Testing in Psychiatry: Ready for Primetime?.J. Nerv. Ment. Dis. 2020; : 1https://doi.org/10.1097/NMD.0000000000001107
- Pharmacogenomic testing and antidepressant response: problems and promises.Braz. J. Psychiatry. 2020; 42: 116-117https://doi.org/10.1590/1516-4446-2019-0799
- Pharmacogenetics in Psychiatry: A Companion, Rather Than Competitor, to Protocol-Based Care.JAMA Psychiatry. 2018; 75: 1090https://doi.org/10.1001/jamapsychiatry.2018.2344
Heise CW, Gallo T, Curry SC, Woosley RL. Identification of populations likely to benefit from pharmacogenomic testing. Pharmacogenet Genomics. March 2020:1. doi:10.1097/FPC.0000000000000400.
Clinical Pharmacogenetics Implementation Consortium. Clinical Pharmacogenetics Implementation Consortium Guidelines. https://cpicpgx.org/guidelines/. Accessed May 8, 2020.
- DSM-5 cross-cutting symptom measures: a step towards the future of psychiatric care?.-. 2014; 13: 314-316
- Developing the World Health Organization Disability Assessment Schedule 2.0.Bull. World Health Organ. 2010; 88: 815-823
Article info
Identification
Copyright
© 2020 Published by Elsevier Inc.
