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Comment & Response
October 2018

Pharmacogenetics in Psychiatry: A Companion, Rather Than Competitor, to Protocol-Based Care—Reply

Author Affiliations
  • 1Distinguished Life Fellow, American Psychiatric Association, Washington, DC
  • 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
  • 3Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
  • 4Program for Neuropsychiatric Research, McLean Hospital, Belmont, Massachusetts
JAMA Psychiatry. 2018;75(10):1090-1091. doi:10.1001/jamapsychiatry.2018.2355

In Reply It is important to note that we made neither of the assumptions attributed to us. We did not assume, nor state or imply, that all pharmacogenomic (Pgen) test panels are the same or that Pgen testing is incompatible with protocol-based care. First, we explained the scientific evidence behind our conclusion that no current panel of genes should be expected to have clinical utility for the treatment of major depressive disorder (MDD). Second, we discussed why published clinical studies provide inadequate evidence to justify the use of current Pgen tests.1 Other independent experts confirm these points, documenting both the lack of scientific evidence behind the panels2 and the inadequacy of studies cited as supporting the clinical use of Pgen tests.3,4 Unfortunately, instead of better studies, larger studies are now being reported. No study has included the needed blinding of all participants or proper treatment comparison groups.1 Even with designs favoring Pgen tests, patients with Pgen-guided treatment did not have clearly better outcomes.1,3,4 These findings suggest currently offered Pgen testing has no clinical value in MDD.