November 2017

In this Issue: Improving Care of Mental Health Conditions
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PRIME Care: PRecision medicine In Mental health Care

Feature Article

Approximately 19% of service members returning from Iraq or Afghanistan have PTSD or depression,¹ and depression is the leading cause of disability worldwide². As shown in several studies, to achieve remission from depression, patients and providers must be persistent and try multiple treatments until they find one that is both tolerable and effective. With each round of treatment, however, there is greater attrition from treatment. In the last several years, commercial pharmacogenetic (PGx) testing for psychotropic medications has become widespread as a means of implementing "precision medicine," with some insurers electing to cover the cost of testing. [Pharmacogenetic testing is a type of genetic testing meant to predict a patient’s likelihood to experience an adverse event or not respond to a given drug.] Despite the rapid increase in commercial products, there is limited scientific study to support the utility of clinical dissemination.

This ongoing (2016-2022), multisite, randomized controlled trial will evaluate the utility of PGx testing in treating major depressive disorder (MDD) with or without concurrent PTSD. Patient/provider dyads (total n=2,000) will be randomly assigned to receive results of the PGx battery right after randomization (intervention group) or after six months of treatment as usual (delayed results group). Exclusion criteria for this study includes current serious co-occurring psychiatric illness (i.e., schizophrenia, bipolar disorder, psychotic major depression), and/or active alcohol or other drug use disorder.

Impact: Replication of results from the limited PGx implementation studies that have been conducted to date could usher in a new era in the treatment of psychiatric disorders and provide an impetus for early diagnosis and treatment, resulting in more rapid and higher rates of remission among Veterans. 

Principal Investigator:  David Oslin, MD, is the Director of the VISN 4 Mental Illness Research Education and Clinical Center (MIRECC) and part of HSR&D’s Center for Health Equity Research & Promotion (CHERP) in Philadelphia, PA.

1. Veterans and Military Families. Substance Abuse and Mental Health Services Administration (SAMHSA).
2. Williams J. Depression is the leading cause of disability around the world. Newsweek. March 2017.

PRIME Care: PRecision medicine In Mental health Care project abstract