Chunk #20 — Current Status of Drug Labeling and Pharmacogenomic Testing Guidelines — Labeling for Selective Serotonin Reuptake Inhibitors

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Pharmacogenomic testing for neuropsychiatric drugs: current status of drug labeling, guidelines for using genetic information, and test options.

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SSRIs are first-line therapies for the treatment of depression, some anxiety disorders, forms of posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). The therapeutic window is thought to be wide for SSRIs with respect to treating depression and anxiety.36 However, for other disease states, such as OCD, there is often a need for higher doses, which can pose a challenge for identifying target doses and titration strategies that must balance the risks of dose-dependent adverse effects with the benefits of dose-dependent response.37 As SSRIs have broad therapeutic windows, use of genetic testing that has implications for dose-related outcomes is controversial. The CYP enzymes, primarily CYP2D6 and CYP2C19, are involved in the metabolism of SSRIs. Moreover, citalopram, fluoxetine, fluvoxamine, and paroxetine are strong inhibitors of CYP2D6 and/or CYP2C19 (citalopram).38