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Bringing PGx Into Adolescent Treatment Plans

Healthcare is continually advancing with innovations in personalized medicine, and pharmacogenomics (PGx) has become an important tool for improving treatment outcomes. While PGx has already provided valuable insights in adult care by revealing how genetic variations influence drug response, its application in youth or adolescents has just started gaining momentum, especially in psychiatry.

This is a critical area where treatment responses often vary widely. For adolescents prescribed selective serotonin reuptake inhibitors (SSRIs), PGx offers the potential to enhance medication effectiveness, reduce the risk of adverse effects, and support more precise, evidence-based care tailored to the individual.

The Case for PGx in Adolescent Psychiatry

Recent findings highlight the growing value of PGx testing in adolescent psychiatry, particularly in tailoring medication strategies. A 2025 study analyzing prescribing patterns across a multistate pediatric health system revealed that a large share of psychiatric medications (especially SSRIs, stimulants, and antipsychotics) are associated with gene-drug interactions recognized by Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines.

These medications are commonly influenced by genetic variations in enzymes like CYP2D6 and CYP2C19, which can alter drug metabolism and impact both effectiveness and side effect profiles. This evidence points to a clear opportunity to incorporate PGx into routine clinical practice to better individualize psychiatric care for youth.

Similarly, another review exploring PGx’s use in youth antidepressant therapy was published, noting that they found evidence supporting the value of pharmacogenetic testing to optimize antidepressant selection, particularly for those with poor response histories or intolerable side effects.

Genetic variants in genes such as CYP2C19 and CYP2D6 can significantly influence SSRI metabolism, affecting both efficacy and tolerability. For example, adolescents who are CYP2C19 poor metabolizers may have higher plasma levels of citalopram or escitalopram, increasing the risk of adverse effects unless dosages are adjusted accordingly.

While PGx has real potential to personalize treatment and reduce side effects, challenges like limited pediatric guidelines and provider awareness still need to be addressed. Overall, these reviews support PGx as a promising tool, but more research is needed to fully validate its role in adolescent psychiatry.

A Multidimensional Approach

Although PGx is sometimes oversimplified into binary “use” or “avoid” categories, experts emphasize the need for more nuanced application. In this editorial, it’s argued that the real promise of PGx in adolescent psychiatry lies in its ability to inform (not dictate) clinical decisions. Meaning PGx should be integrated into a broader assessment that might include symptom severity, treatment history, family history, and psychosocial factors. A multidimensional approach like this allows clinicians to tailor pharmacotherapy while still honoring the complexity of youth mental health care.

Translating PGx Insights Into Clinical Practice

For providers considering integrating PGx into adolescent treatment plans, the following strategies can support its implementation:

1. Start with CPIC-guided medications: CPIC provides peer-reviewed, evidence-based guidelines for medications with known gene-drug interactions. For commonly prescribed SSRIs like escitalopram and sertraline, these guidelines can assist in dosage adjustments based on one’s CYP2C19 and CYP2D6 genotype.

1. Identify high-risk patients: Adolescents with treatment-resistant depression, a history of adverse drug reactions, or significant family histories of medication intolerance are strong candidates for PGx testing.

1. Educate patients and families: Framing PGx as one piece of a personalized care strategy can help families understand its benefits without overestimating its scope. Transparency about the role of genetics in medication response is key.

1. Collaborate across disciplines: Coordination between primary care, psychiatry, and pharmacogenomics specialists ensures that test results are interpreted and applied consistently. Including pharmacists and genetic counselors can further enrich the clinical application.

Summary

Pharmacogenomics represents a significant advancement in adolescent psychiatric care, particularly in optimizing SSRI prescribing and reducing trial-and-error approaches. As evidence continues to mount, PGx offers a practical pathway to improve therapeutic outcomes, enhance safety, and personalize care for young patients navigating complex mental health challenges.

Consider incorporating Scylex PGx panels into your clinical workflow to better serve your adolescent patients with precision and confidence.

Written By:

Vanessa Imus, MS, RDN,

Owner of Integrated Nutrition for Weight Loss

https://inutritioncenter.com/about/