Estimated to affect more than 21 million individuals in the United Stated, major depressive disorder (MDD) is usually treated with psychological therapy and/or antidepressant medication. However, up to 40% of MDD patients don’t respond to treatment. Understanding if a patient’s ability to metabolize certain medications is impacted by genetic variation is integral to guiding treatment selection.

In this test specific episode of the "Answers From the Lab" podcast, Ann Moyer, M.D., Ph.D., and Paul Jannetto, Ph.D., describe how Mayo Clinic’s approach to precision therapeutics can guide clinicians to prescribe the best treatment for individual patients.

“OUR PHARMACOGENOMIC TESTING CAN HELP NARROW DOWN THE OPTIONS FOR WHICH MEDICATION MIGHT BE THE MOST EFFECTIVE CHOICE FOR AN INDIVIDUAL PATIENT,” DR. MOYER SAYS. “I’D RECOMMEND ESPECIALLY TESTING PATIENTS WHO HAVE TRIED SEVERAL MEDICATIONS AND ARE STILL UNABLE TO ACHIEVE SYMPTOM CONTROL. FOR PATIENTS WHO HAVEN’T TRIED ANTIDEPRESSANTS YET, THE TESTING MIGHT SHORTEN THAT TRIAL-AND-ERROR PERIOD.”

Mayo Clinic Laboratories precision therapeutics offerings include pharmacogenomic (PGx) testing and therapeutic drug monitoring (TDM).

Our PGx panel uses whole blood to extract and evaluate a patient’s DNA for variants in individual genes with relevance to metabolism of selective serotonin reuptake inhibitors, or SSRIs, a drug class commonly used to treat MDD. TDM, which is performed three to four weeks after a patient begins or changes medications, measures drug concentrations in serum to determine if the prescribed dose is optimal. Our TDM testing evaluates for SSRIs and tricyclic antidepressants.

“Therapeutic drug monitoring considers inter-individual variability,” Dr. Jannetto says. “Numerous demographic, disease-related, chemical, or environmental factors can affect drug concentrations. Some patients will require much higher doses, or sometimes even sub-therapeutic concentrations, to achieve clinical success.”

Incorporating PGx testing into clinical practice as an adjust or in advance of TDM provides physicians with personalized insights to identify and avoid adverse drug reactions. “Both pharmacogenomics and therapeutic drug monitoring can help maximize efficacy while minimizing toxicity for antidepressant therapy,” Dr. Jannetto says.

Listen to learn more about how Mayo Clinic Laboratories’ precision therapeutics can improve the treatment of major depressive disorder.

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