Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review

Bradley Roberts; Zahra Cooper; Stephanie Lu; Susanne Stanley; Bernadette T Majda; Khan R L Collins; Lucy Gilkes; Jennifer Rodger; P Anthony Akkari; Sean D Hood

doi:10.3389/fphar.2023.1267294

Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review

Front Pharmacol. 2023 Sep 19:14:1267294. doi: 10.3389/fphar.2023.1267294. eCollection 2023.

Authors

Bradley Roberts^#^{1

2}, Zahra Cooper^#¹, Stephanie Lu³, Susanne Stanley⁴, Bernadette T Majda⁵, Khan R L Collins⁶, Lucy Gilkes^{5

7}, Jennifer Rodger^{1

2}, P Anthony Akkari^{1

8

9

10}, Sean D Hood^#⁴

Affiliations

¹ The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia.
² School of Biological Sciences, University of Western Australia, Crawley, WA, Australia.
³ School of Psychological Science, University of Western Australia, Crawley, WA, Australia.
⁴ Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia.
⁵ School of Medicine, University of Notre Dame, Fremantle, WA, Australia.
⁶ Western Australian Department of Health, North Metropolitan Health Service, Perth, WA, Australia.
⁷ Divison of General Practice, School of Medicine, University of Western Australia, Crawley, WA, Australia.
⁸ School of Human Sciences, University of Western Australia, Crawley, WA, Australia.
⁹ Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia.
¹⁰ Division of Neurology, Duke University Medical Centre, Duke University, Durham, United States.

^# Contributed equally.

Abstract

Pharmacogenetics (PGx) is the study and application of how interindividual differences in our genomes can influence drug responses. By evaluating individuals' genetic variability in genes related to drug metabolism, PGx testing has the capabilities to individualise primary care and build a safer drug prescription model than the current "one-size-fits-all" approach. In particular, the use of PGx testing in psychiatry has shown promising evidence in improving drug efficacy as well as reducing toxicity and adverse drug reactions. Despite randomised controlled trials demonstrating an evidence base for its use, there are still numerous barriers impeding its implementation. This review paper will discuss the management of mental health conditions with PGx-guided treatment with a strong focus on youth mental illness. PGx testing in clinical practice, the concerns for its implementation in youth psychiatry, and some of the barriers inhibiting its integration in clinical healthcare will also be discussed. Overall, this paper provides a comprehensive review of the current state of knowledge and application for PGx in psychiatry and summarises the capabilities of genetic information to personalising medicine for the treatment of mental ill-health in youth.

Keywords: anxiety; cytochrome P450; depression; drug metabolism; personalised medicine; pharmacogenetics; pharmacogenomics; youth mental health.

Publication types

Review

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. BR was supported by an Australian Government Research Training Program (RTP), and a Perron Institute Byron Kakulas Prestige scholarship. The funders had no role in the preparation of the review and the decision to publish.