Behavioral Health Update: Pharmacogenomic Testing in Depression: Still Not Ready for Routine Use
May 30th, 2025 | Behavioral Health•NewsGeorge Nasra, MD, MBA
Associate Medical Director of Behavioral Health
Accountable Health Partners
We are pleased to share important updates and resources related to behavioral health services. This month, we discuss how interest in using genetic testing to guide antidepressant prescribing has grown rapidly in recent years.
Many patients and clinicians hope these tests can reduce the trial-and-error process of finding the right medication. Despite this enthusiasm—and the increasing number of commercial products on the market—a new review commissioned by the American Psychiatric Association finds that the clinical evidence still does not support the routine use of pharmacogenomic (PGx) testing to guide antidepressant selection in everyday care.
Dr. Matthew Baum, Dr. Alik Widge, and Dr. Linda Carpenter et al. reviewed 11 clinical trials and 5 meta-analyses published since 2017. Most trials failed to meet their primary outcomes, and none used fully blinded study designs, leaving results vulnerable to bias. Some post hoc analyses showed modest benefits in symptom improvement or side effect profiles, but overall, the quality of evidence remains insufficient to change practice. The U.S. Food and Drug Administration (FDA) continues to warn clinicians not to rely on PGx tests when choosing antidepressants, except in very limited cases involving well-known gene-drug interactions.
Bottom line for primary care providers: While the idea of personalized antidepressant treatment through genetic testing is appealing, the current evidence does not support its widespread use in routine clinical practice. Following established clinical guidelines and monitoring patient response over time remains the most reliable approach.
Reference: Baum ML, Widge AS, Carpenter LL, et al. Pharmacogenomic Clinical Support Tools for the Treatment of Depression. Am J Psychiatry. 2024;181(7):591–607. doi:10.1176/appi.ajp.20230657
