Depression and Personalized Medicine: Is Genetic Testing the Future?

By Valerie Piet · Apr 2019

Earlier this year, the FDA approved a version of ketamine for treating depression — the first novel psychiatric drug in 30 years. But ketamine isn't the only emerging innovation. Since the early 2000s, efforts have been underway to incorporate pharmacogenetic testing into the treatment of depression.

The Idea Behind Psychiatric Pharmacogenetics

The premise: genetic variants in certain metabolic enzymes (particularly the CYP450 family) affect how quickly drugs are processed. If a patient metabolizes a drug too quickly, it may not be in the body long enough to work; too slowly, and toxic levels can accumulate. Companies like Genesight, Genelex, and Genomind offer tests that analyze multiple gene variants and produce recommendations about which medications are most likely to be effective for a given patient.

The Honest Answer: Not Yet

A 2018 American Psychiatric Association Task Force concluded there is not currently enough sound data to recommend genetic testing in the clinical management of depression. Studies showing improved outcomes tend to be small, short-term, and often funded by the testing companies themselves. The proprietary nature of the algorithms makes outside validation difficult. Efficacy issues with antidepressants more commonly stem from adherence and resistance, not metabolic genetics. Pharmacogenomics for psychiatry is an area worth watching — but we're not there yet clinically.