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Review
. 2015 Nov 24;88(4):375-82.
eCollection 2015 Dec.

Combinatorial Versus Individual Gene Pharmacogenomic Testing in Mental Health: A Perspective on Context and Implications on Clinical Utility

Joel G Winner  1 , Bryan Dechairo  1
Affiliations
Review

Combinatorial Versus Individual Gene Pharmacogenomic Testing in Mental Health: A Perspective on Context and Implications on Clinical Utility

Joel G Winner et al. Yale J Biol Med. .

Abstract

Pharmacogenomic testing in mental health has not yet reached its full potential. An important reason for this involves differentiating individual gene testing (IGT) from a combinatorial pharmacogenomic (CPGx) approach. With IGT, any given gene reveals specific information that may, in turn, pertain to a smaller number of medications. CPGx approaches attempt to encompass more complete genomic information by combining moderate risk alleles and synergistically viewing the results from the perspective of the medication. This manuscript will discuss IGT and CPGx approaches to psychiatric pharmacogenomics and review the clinical validity, clinical utility, and economic parameters of both.

Keywords: clinical utility; clinical validity; combinatorial; economic outcomes; mental health; pharmacogenomics.

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Figures

Figure 1
Figure 1
Metabolism flowchart for escitalopram including relevant P450 enzymes.
Figure 2
Figure 2
Metabolism flowchart for amitriptyline and nortriptyline including relevant P450 enzymes.
Figure 3
Figure 3
GeneSight combinatorial process.
Figure 4
Figure 4
Example GeneSight Psychotropic results for antidepressants for an individual patient.
Figure 5
Figure 5
Clinical outcomes of blinded subjects treated without pharmacogenomic testing by GeneSight CPGx advisory category (pooled data from three trials).
See this image and copyright information in PMC

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