“I have data, I have science behind my treatment plan”: A qualitative study of clinician and patient views and experiences with pharmacogenomic testing for depression

Background: Pharmacogenomic (PGx) testing for depression medication can identify individuals whose genetic profile may be suggestive of either increased risk of side effects or lack of response. While use of testing is increasing, there are ongoing debates about its clinical utility. However, there have been few studies exploring the experiences of patients and clinicians with using these tests in real world situations.

Methods: Semi-structured interviews were conducted with 10 clinicians and 10 patients who have either ordered or undergone PGx testing. Interviews explored their views of the benefits and limitations of PGx testing within the context of their broader experiences treating and being treated for depression. Interviews were thematically coded following a modified grounded theory approach using the Dedoose software.

Results: Patients' experience of testing was shaped by their own frustrating experiences seeking mental health care, which included unstable access to care, stigma, conflicts with providers, and a lack of personalization of care. Testing not only validated their experiences with medication and depression, but it also provided reassurance that medication selection was not random, and that they were not “guinea pigs.” Similarly, there was thematic agreement among clinicians that testing improved the process of medication selection for patients by providing reassurance, validation, hope, and education about how medications are absorbed in the body.

Discussion: The focus on clinical utility of pharmacogenomics for depression may miss some of the key personal utility benefits for patients which are shaped by the difficulties of accessing mental health care in the United States.

Authors: Katherine Hendy, Department of Health Behavior and Health Education, University of Michigan School of Public Health; Scott Roberts; Department of Health Behavior and Health Education, University of Michigan School of Public Health; Vicki Ellingrod, College of Pharmacy, University of Michigan