Review and Consensus on Pharmacogenomic Testing in Psychiatry

Area of Science:

• Psychiatric Genetics
• Pharmacogenomics
• Clinical Pharmacology

Background:

• Implementation of pharmacogenomic (PGx) testing in psychiatry is limited by varied evidence quality perceptions and clinical utility perspectives.
• A lack of consensus necessitates expert review of PGx literature, guidelines, and product labels for psychotropic medications.

Purpose of the Study:

• To synthesize the current evidence base for PGx testing in psychiatry.
• To provide guidance on the use of PGx testing for psychotropic medication selection and dosing.
• To identify key considerations and limitations of PGx testing in psychiatric practice.

Main Methods:

• Narrative synthesis of pharmacogenomic literature.
• Review of prescribing guidelines and drug product labels for psychotropic medications.
• Expert consensus development on PGx testing applications in psychiatry.

Main Results:

• Published evidence, guidelines, and labels support PGx testing for CYP2D6 and CYP2C19 to inform antidepressant and antipsychotic selection/dosing.
• Evidence supports HLA gene testing for carbamazepine, oxcarbazepine, and phenytoin, and specific gene screening for valproate under certain conditions.
• Barriers to PGx implementation persist but are expected to be overcome with ongoing innovation.

Conclusions:

• PGx testing is supported for specific gene-drug pairs in psychiatry, including CYP450 genes for common antidepressants/antipsychotics and HLA genes for certain mood stabilizers.
• PGx testing holds significant potential to become an integral tool in psychiatric practice, improving medication management.
• Continued research and resolution of implementation barriers will facilitate broader adoption of PGx testing in psychiatry.