Pharmacogenomic Testing in Major Depressive Disorder

Columbia University38 enrolled

Overview

This is a two-arm double-blind prospective randomized controlled trial (RCT) to evaluate clinical impact of pharmacogenomic testing on the treatment of major depressive disorder. Participants will be randomly assigned to two groups: pharmacogenomic-guided therapy group (guided group) and treatment as usual group (TAU group). The primary hypothesis is the pharmacogenomic-guided treatment group will demonstrate significantly higher percent improvement in depression score compared to treatment-as-usual group.

To a large extent, variability in antidepressant efficacy can be explained by genetic variations that affect medication-metabolizing enzymes, drug transporters, and medication targets. Recent reviews demonstrated significant potential of pharmacogenomic testing in improving treatment of major depressive disorder. One of the major barriers towards successful implementation of pharmacogenomic testing for patients with major depressive disorder is lack of systematic evaluation of impact of this approach in routine clinical care settings. The major goal of this study is to systematically evaluate impact of comprehensive pharmacogenomic testing on the treatment of major depressive disorder in ambulatory setting.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

DOUBLE

Enrollment

Conditions

Major Depressive Disorder

Interventions

Pharmacogenomic testingOTHER

Pharmacogenomic testing is delivered to treating providers of patients with major depressive disorder

Eligibility

Sex: ALLMin age: 21 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Clinical diagnosis of major depressive disorder (MDD) 2. Prescription of index antidepressant medications 3. Minimum score of 14 on the 17-item Hamilton Rating Scale for Depression (HAMD-17) Exclusion Criteria: 1. Diagnosis of bipolar disorder (any type), schizophrenia, or schizoaffective disorders 2. Active diagnosis of substance abuse or dependence 3. Current suicidal ideation 4. Previous suicidal attempts 5. A person has already had pharmacogenetic testing done.

Locations (1)

Columbia University Irving Medical Center

New York, New York, United States

Outcomes

Primary Outcomes

Score on the Hamilton Rating Scale for Depression (HAMD-17)

The patient is rated by a clinician among 17 dimensions with a score on a 3 or 5 point scale. A score of 0-7 is considered to be normal. Scores of 20 or higher indicate moderate, severe, or very severe depression, and are usually required for entry into a clinical trial.

Time frame: Up to 10 weeks

Secondary Outcomes

Score on Subject-Rated 16-item Quick Inventory of Depression Symptomatology Scales (QIDS-SR)

The Quick Inventory of Depressive Symptomatology is a short screening tool based on the larger Inventory of Depressive Symptomatology (IDS). Each item is scored on a scale from 0 to 3 points. Total scores range from 0 (no depression) to 27 (severe depression).

Time frame: Up to 10 weeks

Score on the 9-item Patient Health Questionnaire (PHQ-9)

The PHQ-9 is the depression module, which scores each of the nine DSM-IV criteria as "0" (not at all) to "3" (nearly every day). Higher PHQ-9 scores are associated with decreased functional status and increased symptom-related difficulties, sick days and healthcare utilization.

Time frame: Up to 10 weeks

Data from ClinicalTrials.gov

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