School of Law, University of Surrey, Guildford, UK; Department of Medicine for Abbott, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
School of Medicine, Ochsner Clinical School, University of Queensland, Brisbane, Queensland, Australia.
Am J Geriatr Psychiatry. 2018 Feb;26(2):125-133. doi: 10.1016/j.jagp.2017.05.012. Epub 2017 May 25.
Clinicians still employ a "trial-and-error" approach to optimizing treatment regimens for late-life depression (LLD). With LLD affecting a significant and growing segment of the population, and with only about half of older adults responsive to antidepressant therapy, there is an urgent need for a better treatment paradigm. Pharmacogenetic decision support tools (DSTs), which are emerging technologies that aim to provide clinically actionable information based on a patient's genetic profile, offer a promising solution. Dozens of DSTs have entered the market in the past 15 years, but with varying level of empirical evidence to support their value. In this clinical review, we provide a critical analysis of the peer-reviewed literature on DSTs for major depression management. We then discuss clinical considerations for the use of these tools in treating LLD, including issues related to test interpretation, timing, and patient perspectives. In adult populations, newer generation DSTs show promise for the treatment of major depression. However, there are no primary clinical trials in LLD cohorts. Independent and comparative clinical trials are needed.
临床医生在优化治疗老年人抑郁症（LLD）的方案时仍然采用“试错”的方法。随着 LLD 影响到人口中的一个重要且不断增长的部分，并且只有大约一半的老年人对抗抑郁治疗有反应，因此迫切需要更好的治疗模式。药物遗传学决策支持工具（DST）是一种新兴技术，旨在根据患者的基因谱提供临床可行的信息，提供了一种有前途的解决方案。在过去的 15 年中，已有数十种 DST 进入市场，但它们的价值的支持证据水平不一。在本临床综述中，我们对 DST 用于治疗主要抑郁症的文献进行了批判性分析。然后，我们讨论了在治疗 LLD 中使用这些工具的临床注意事项，包括与测试解释、时间安排和患者观点相关的问题。在成年人群中，新一代 DST 显示出治疗主要抑郁症的潜力。但是，在 LLD 队列中没有主要的临床试验。需要独立的和比较的临床试验。
