Key Questions:

• Question 1: Does testing for CYP450 polymorphisms in adults entering SSRI treatment for non-psychotic depression lead to improvement in outcomes, or are testing results useful in medical, personal, or public health decisionmaking? (overarching question)

• Question 2: What is the analytic validity of tests that identify key CYP450 polymorphisms?

• Question 3a: How well do particular CYP450 genotypes predict metabolism of particular SSRIs? Do factors such as race/ethnicity, diet, or other medications, affect this association?

• Question 3b: How well does CYP450 testing predict drug efficacy? Do factors such as race/ethnicity, diet, or other medications, affect this association?

• Question 3c: How well does CYP450 testing predict adverse drug reactions? Do factors such as race/ethnicity, diet, or other medications, affect this association?

• Question 4a: Does CYP450 testing influence depression management decisions by patients and providers in ways that could improve or worsen outcomes?

• Question 4b: Does the identification of the CYP450 genotypes in adults entering SSRI treatment for non-psychotic depression lead to improved clinical outcomes compared to not testing?

• Question 4c: Are the testing results useful in medical, personal or public health decision-making?

• Question 5: What are the harms associated with testing for CYP450 polymorphisms and subsequent management options?

Why EGAPP Selected this topic for Review:

Key criteria: Depression is common and has significant health impact; SSRIs are commonly prescribed for depression in the US; FDA approved test with potential for impact on practice; potential for broad clinical application of the test for other drugs metabolized by CYP450 enzymes.

Other Considerations: A new technology with limited literature that challenges EGAPP methodology.