Pharmacogenetic-Guided Antidepressant Prescribing in Adolescents With Anxiety and Depression
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Pharmacogenetic-guided dosing, Current prescribing guidelines/recommendations.
- Who it may be relevant to
- Registry conditions: Anxiety and Depression. Basic parameters: 12 years — 17 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Canada
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
This is a parallel arm randomized (1:1) controlled trial. Adolescents aged 12-17 years (n=228) who are starting or changing a selective serotonin reuptake inhibitor (SSRI) for depression and/or anxiety will be randomly allocated to receive 12-weeks of pharmacogenetic-guided antidepressant therapy (experimental intervention) or current prescribing guidelines/recommendations guided therapy (control intervention).
Detailed description
Goal: To test the efficacy of pharmacogenetic-guided antidepressant prescribing for adolescents with depression.
Background: For an adolescent with depression and anxiety, antidepressant medication is prescribed, often in combination with psychotherapy. The class of antidepressants recommended for use is selective serotonin reuptake inhibitors (SSRIs) with fluoxetine recommended as the first-line medication, and four other SSRIs recommended for consideration (sertraline, citalopram, escitalopram, fluvoxamine) if the adolescent does not respond or tolerate fluoxetine. For most adolescents, medication prescribing, and monitoring will be managed by a primary care physician or community pediatrician rather than by a mental health care provider, and guidelines exist to support this management. However, current prescribing guidelines/recommendations do not account for SSRI metabolism phenotypes that could change whether the SSRI selected is efficacious or tolerated. Our team of researchers, clinician scientists, patient partners, and primary care providers has designed a trial to test the impact of accounting for metabolism phenotypes, through pharmacogenetic-guided antidepressant prescribing, on adolescent outcomes, experiences, and health care utilization.
Principal Question: Compared to current prescribing guideline/recommendation informed prescribing, does pharmacogenetic-guided prescribing for adolescents with depression and/or anxiety have superior efficacy following 12-weeks of therapy with a SSRI?
The Trial: This is a parallel arm randomized controlled trial. Adolescents aged 12-17 years (n=228) who are starting or changing a SSRI for depression and/or anxiety will be randomly allocated to receive pharmacogenetic-guided antidepressant therapy (experimental intervention) or current prescribing guideline/recommendation guided prescribing (control intervention). Participants and prescribing physicians will be blinded to which intervention was received. The primary outcome is depressive symptom remission at 12 weeks measured using the Quick Inventory of Depressive Symptomatology - Adolescent (17-item) (QIDS-A17) and anxiety symptom remission at 12 weeks measures using the Screen for Child Anxiety Related Disorders (SCARED). Secondary outcomes include side effects, role functioning, medication adherence, and health-related quality of life measured 4-, 8-, and 12-weeks after intervention initiation as well as cost-effectiveness.
Interventions
- Other Pharmacogenetic-guided dosing
SSRI dosing based on Clinical Pharmacogenetics Implementation Consortium's SSRI dosing guidelines. - Other Current prescribing guidelines/recommendations
SSRI dosing based on current prescribing guidelines/recommendations
Primary outcome measures
- Number of participants with depression remission [Time frame: Baseline to 12 weeks]
- Number of participants with anxiety remission [Time frame: Baseline to 12 weeks]
Secondary outcome measures (12)
- Number of participants with side effects and adverse drug reactions [Time frame: Baseline to 12 weeks]
- Percent change in role functioning [Time frame: Baseline to 12 weeks]
- Percent change in depressive symptom severity [Time frame: Baseline to 12 weeks]
- Percent change in anxiety symptom severity [Time frame: Baseline to 12 weeks]
- Percent change in clinician assessment of depressive and anxiety symptom severity [Time frame: Baseline to 12 weeks]
- Change in self-report health care resource use [Time frame: Baseline to 12 weeks]
- Change in healthcare utilization - physician visits [Time frame: Baseline to 12 weeks]
- Change in health care utilization - emergency department visits [Time frame: Baseline to 12 weeks]
- Change in health care utilization - hospitalizations [Time frame: Baseline to 12 weeks]
- Change in prescribed medication dose [Time frame: Baseline to 12 weeks]
- Change in prescribed agent [Time frame: Baseline to 12 weeks]
- Change in prescribed medication duration [Time frame: Baseline to 12 weeks]
Eligibility criteria
Inclusion criteria
- Age 12-17
- Depression and/or anxiety as the primary concern, confirmed by the treating physician
- Intention to start a new SSRI
- English fluency
Exclusion criteria
- Co-occurring obsessive compulsive disorder, psychosis, bipolar disorder, eating disorder, autism spectrum disorder, fetal alcohol spectrum disorder, or intellectual disability
- History of non-response to 3 or more SSRI medications as confirmed by the treating physician
- Brain stimulation-based therapy initiated within 8 weeks of referral, or plans to initiate/change brain stimulation during study participation
- History of liver or hematopoietic cell transplant
- History of CYP2B6, CYP2C19, or CYP2D6 testing
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Quadruple blind
- Primary purpose
- Treatment
Study locations
Canada · 1 center
- University of Calgary — Calgary
Identifiers
NCT: NCT06853587 · 2025-23-0532