Abstract
Background
Pharmacogenetics (PGx) is the study of how interindividual genetic variation can alter drug metabolism and the response to medication. By evaluating common genetic markers in genes encoding drug-metabolising enzymes, PGx testing has demonstrated the potential to individualise pharmacotherapy, offering a more personalised treatment plan to improve drug efficacy and tolerability. In clinical use, PGx testing has been shown to reduce the process of medication trial-and-error. However, in Australian psychiatric care, PGx testing is seldom used to personalise antidepressant treatment plans for people with depression and/or anxiety. With the rising prevalence of depression and anxiety in young Australians, coupled with the limitations of conventional antidepressant treatment, PGx testing has shown promise in optimising medication selection. Given the drive for further clinical integration of PGx testing in youth psychiatric care, it is essential to first understand the perspectives and concerns of key stakeholders regarding its implementation.
Aims & Objectives
This study aimed to assess the attitudes of young adults towards PGx testing for guiding antidepressant treatment, focusing on their perceived advantages, concerns, and anticipated barriers to its clinical adoption.
Method
Semi-structured focus groups and interviews were employed, engaging with participants aged 18–24 years who had prior or current antidepressant experience. Sessions were recorded and transcribed verbatim. Reflexive thematic analysis was conducted to code, refine, and identify prevalent themes, encompassing perspectives on current treatment, views on PGx, and clinical integration barriers.
Results
Saturation was reached after nine sessions with a total of 17 participants. Three primary themes emerged from the analysis: (1) attitudes towards current antidepressant prescription practices, (2) perspectives and concerns towards PGx testing, and (3) perceived barriers to PGx implementation. Participants appreciated PGx’s potential to reduce the trial-and-error approach, improve medication selection, and potentially minimise medication-related side effects. However, concerns included the high perceived cost of PGx testing, anticipated delays in treatment initiation, and scepticism regarding the efficacy of such genetically guided treatment. Furthermore, participants believed that GPs’ awareness, willingness, and knowledge to incorporate PGx results in treatment plans would act as a key barrier to PGx implementation.
Discussion & Conclusions
This study highlights significant gaps in youth mental health treatment, including the limited involvement of youth patients in medication decision-making. Participants viewed PGx testing as a promising step toward personalised treatment, provided concerns around cost, accessibility, and testing accuracy are addressed. Furthermore, education and awareness campaigns around PGx testing were viewed as necessary for both patients and healthcare providers to facilitate integration into clinical use. The findings from this study highlight the importance of recognising patient perspectives when integrating medical practices into healthcare, ensuring that the implementation of PGx testing in Australian psychiatric practices remains patient-focused, upholding the needs and expectations of those receiving care. Furthermore, these findings have helped to inform the design and outcomes of an ongoing pilot randomised controlled trial aimed at evaluating the efficacy and tolerability of PGx-guided antidepressant pharmacotherapy in youth. This trial, conducted at the Perron Institute for Neurological and Translational Science, aims to address the youth concerns expressed in this qualitative study.