Use of PHQ-9 and pharmacogenetic testing in clinical practice

Abstract

Background: This project evaluated the clinical use of pharmacogenetic testing in an outpatient psychiatric practice, integrated a standardized measure for assessing depressive symptoms, and captured data regarding treatment efficacy. Local Problem: According to the Centers for Disease Control and Prevention (2016), more than 10% of all outpatient office visits include a depression-related diagnosis. Patients who require more medication trials to experience remission of depressive symptoms are more likely to relapse in the follow-up period than those who do not (National Institute of Mental Health, 2001). Methods and Interventions: Baseline Patient Health Questionnaire-9 (PHQ-9) scores and medication regimens were recorded for 15 adults with major depressive disorder who completed pharmacogenetic testing. Repeat PHQ-9 scores and medication regimens were recorded at follow-up appointments within 6 weeks post-pharmacogenetic testing and compared with baseline data. Results: The PHQ-9 scores ranged from a 5-point reduction to a 2-point increase in depressive symptoms at follow-up appointment. The PHQ-9 scores were lower at follow-up screening for 14 participants. Six of the 15 participants were on a single medication, with significant drug–gene interactions. Medications with significant drug–gene interactions were eliminated from the regimen for three of the six patients. For the remaining three patients, providers deemed it to be reasonable to continue the medications with significant drug–gene interactions. Conclusions: Pharmacogenetic testing is a useful clinical tool for guiding medication selection but does not replace provider judgment. Drug–gene interaction testing results should be considered in addition to patient preference, medication cost, possible side effects, and immediate clinical needs.

Pharmacogenomic Testing in Depression: A 2021 Update

“…These comprised 1 SR, 9 1 HTA, 10 4 RCTs, [11][12][13][14][15] 1 NRS, 16 1 cohort study with historical control, 17 and 2 uncontrolled before-and-after studies. 18,19 Of the RCTs, 2 publications by Ruaño et al reported results from the same trial: 13,14 1 study described the main results 13 and the other summarized findings based on subgroup analyses. 14 The publication by Huilei et al 16 described an intervention study; however, since randomization was not mentioned, it is assumed that the study was non-randomized for the purpose of this report.…”

“…The authors of the included SR were from Qatar 9 and those who authored the HTA 10 were from Canada. Of the remaining 8 studies (where 1 was reported in 2 publications), 4 were conducted in the US, 11,13,14,18,19 1 in Canada, 12 1 in Russia, 15 1 in China, 16 and 1 in Germany 17 (the primary author's affiliations were both Switzerland and Germany).…”

“…Populations in the included primary studies were adults who had a variety of conditions such as MDD, bipolar disorder, posttraumatic stress disorder (PTSD), and generalized anxiety disorder. [11][12][13][14][15][16][17][18][19] One study 15 included patients who had comorbid affective disorder and alcohol addiction. The studies included in the current report varied in their descriptions of whether patients had already tried previous AD therapy that had been unsuccessful.…”

“…Five studies reported in 6 publications took place in single hospital/health care centre setting, [13][14][15][16][17][18] 1 study was in a veteran centre, 11 1 study was in an urban community pharmacy, 12 and 1 study took place in an outpatient centre. 19 Total study population sizes ranged from 15 to 1,459 participants. For the studies that provided age data, ages ranged from 18 to 85 years and the mean age in specific study populations ranged from 36.6 to 52.5 years.…”

“…One study included a male-only population. 15 Male and female participants each represented approximately half of study populations in 4 articles; 13,14,17,19 female participants were a greater proportion in 2 studies (ranging from 72% to 75.93%) 12,18 and male participants were the greater proportion in the other 2 studies. 11,16…”