University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Primary Care


Dr. Laura Witte, PhD, PA-C




The purpose of this clinical review is to summarize current knowledge on utilizing pharmacogenetic guided antidepressant therapy for adults with MDD from a primary care lens.


This reviewer conducted a comprehensive examination of relevant literature gathered from PubMed, Cochrane Review, and Google Scholar published in the past 5 years. Included research focuses on evaluating efficacy, adverse effects, and economic cost-benefit analysis compared to treatment as usual. Additionally, this review includes relevant data from reference lists and national health statistics.


Pharmacogenetic guided management leads to better efficacy outcomes in adult patients with moderate to severe treatment-resistant depression. The use of guided management to lower rates of adverse effects is mildly supported. However, this data is based on limited and heterogenous data, requiring further study to determine the cost-benefit of testing. Pharmacogenetic testing should not be limited to psychiatric facilities. The majority of studies utilized clinicians who were untrained in assay interpretation. Non-psychiatric clinicians were more likely to adhere to pharmacogenetic recommendations, and patients managed by primary care clinicians reported better efficacy. There is an economic utility in pharmacogenetic testing for treatment resistant depression. Within 3 years, patients with severe treatment resistant depression saved an average of 4500 USD in direct and indirect costs.


Pharmacogenetic guided antidepressant selection can assist primary care clinicians in managing patients with moderate to severe depression. Patients who have failed one prior medication trial, are more likely to benefit from genetic testing, experience better efficacy, and reduced long-term health costs.


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