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Genetic Tests in the Treatment of Depression Not Yet Useful

mall number of people, did not test for all variations of the enzymes, and were poorly designed, according to the researchers. The majority of studies also reported the rate of metabolism after just one dose or were done in patients without depression—factors that do not accurately represent the long-term use of these drugs in patients with depression.

Because patient response to SSRIs varies, there has been strong interest in using gene-based tests to predict whether the person will be a poor, intermediate, extensive, or ultra-rapid metabolizer. Theoretically, ultra-rapid metabolizers could require higher doses than those who metabolize the drug slowly. Poor metabolizers might respond to a lower dose, which could also prevent side effects. The goal of testing is to personalize health care by selecting therapy based on a patient’s genetic makeup.

The report found a relationship between genetic differences and the occurrence of adverse effects from SSRIs in depressed patients in only two of six studies. However, the researchers concluded that all six studies were poorly designed, which limits the ability to draw conclusions about how differences in CYP450 genes influence adverse effects of SSRIs.

'This report emphasizes that well-designed observational studies and clinical trials are needed to clearly establish the clinical validity and utility of the many emerging genomic tests for treatment and prevention of common diseases of public health significance,' said Muin Khoury, M.D., Ph.D., director of CDC’s National Office of Public Health Genomics. 'Early availability of the evidence base is key to the effective use of genomics for the benefit of population health.'

Since their introduction in the late 1980s, SSRIs (such as citalopram, fluoxetine, paroxetine, and sertraline) have become the most commonly prescribed class of drugs for treatment of depression. However, the likelihood that a person will experience relief f
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