Individualized insights to guide and monitor pharmacotherapy
Optimizing outcomes for complex mood disorders
Major depressive disorder (MDD) and associated mood syndromes are among the most common mental health disorders and a continually expanding burden on health care systems. For patients affected by these complex syndromes — which vary in clinical presentation — timely, effective treatment can have a positive impact on their quality of life.
Key to successful outcomes is determining the right psychotropic medication. This answer, however, is different for every patient.
By the numbers
million adults in the U.S. are affected by mood disorders1
economic burden in the U.S. to treat MDD in 2018 2
of patients affected by MDD do not respond to pharmacotherapy 3
Personalizing care through precision medicine
Understanding if a patient is affected by genetic variations associated with altered metabolism of certain medications that make them resistant to treatment is integral to guiding treatment selection. Pharmacogenomics (PGx), or genetic testing used to inform medication selection and dosing, has the potential to revolutionize medication selection.
Incorporating PGx testing into clinical practice as an adjunct to or in advance of therapeutic drug monitoring (TDM), which quantifies drug concentrations in the blood, provides physicians and psychiatrists with personalized insights to identify and avoid adverse drug reactions. In instances of poor treatment response, PGx facilitates developing individualized treatment plans based on probable medication response.
This approach not only maximizes therapeutic efficacy, it minimizes toxicity, improves medication adherence, and lowers overall cost of care.4 For optimal outcomes, both PGx and therapeutic drug monitoring must be interpreted in the full context of a patient’s clinical picture, including demographic and clinical characteristics.
Beyond the test result
When you partner with Mayo Clinic Laboratories, you extend your network to include some of the world’s leading genetic experts, toxicologists, and laboratory scientists. Our integration with the clinical practice at Mayo Clinic ensures our testing is informed and supported by Mayo Clinic physicians who are part of one of the nation’s top-ranked psychiatric hospitals. Mayo Clinic clinicians, laboratorians, and genetic counselors are available to discuss testing options, interpret results, or help with case review and coordination.
Twenty-four hours a day, seven days a week, our physicians and scientists are available to answer questions and provide support on test ordering and result interpretation.
Comprehensive genotyping for psychotropic medications
Single gene-genotyping for tricyclic antidepressants and selective serotonin reuptake inhibitors5,6
Inter-individual differences in tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) pharmacokinetic parameters and treatment outcomes are associated with CYP2D6 and CYP2C19 genetic variants. With some drugs being affected by CYP2D6 only (e.g., amitriptyline) and others by both polymorphic enzymes (e.g., clomipramine), focused testing is recommended.
Known drug-gene associations
Carbamazepine response and hypersensitivity monitoring7
Human leukocyte antigen (HLA) genetic variation is implicated in the development of specific cutaneous adverse reactions to aromatic anticonvulsants. To reduce the incidence of serious, and sometimes fatal, cutaneous adverse reactions to carbamazepine and oxcarbazepine, identifying those who are at significant risk through HLA-B*15:02 and HLA-A*31:01 genotyping is recommended.
Known drug-gene associations
Therapeutic drug monitoring for antidepressants8
Tricyclic antidepressants (TCAs)
CLOM | Clomipramine, Serum
DESPR | Desipramine, Serum
DXPIN | Doxepin and Nordoxepin, Serum
NOTRP | Nortriptyline, Serum
TRMP | Trimipramine, Serum
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
VENLA | Venlafaxine, Serum
Select serotonin reuptake inhibitors (SSRIs)
DULOX | Duloxetine, Serum
FLUOX | Fluoxetine, Serum
CITAL | Citalopram, Serum
PARO | Paroxetine, Serum
Therapeutic drug monitoring for mood stabilizers
CARF | Carbamazepine, Free, Serum
CARTA | Carbamazepine, Total, Serum
CARTF | Carbamazepine Profile, Serum
LAMO | Lamotrigine, Serum
LITH | Lithium, Serum
VALPF | Valproic Acid Free, Serum
A Test in Focus
Ann Moyer, M.D., Ph.D., and Paul Jannetto, Ph.D., explain how precision therapeutics can improve treatment for patients with major depressive disorder. The optimal antidepressant medication and dose vary among individuals. Pharmacogenomic testing and therapeutic drug monitoring can guide clinicians to the most-effective treatment for each patient.