Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Whether genotyping P450 tests (CYP450 tests)are effective in 1)accurately assessing individuals' metabolic processing of various antidepressants and 2)are effective in predicting the appropriate antidepressants for refractory chronic depression.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Researchers select patients with chronic refractory depression and document antidepressant history and effectiveness. They then perform the CYP450 testing to determine any correlation between a patient's genetic composition and the success of antidepressants previously prescribed. If the genetic testing results that other medications would be more effective, the medication is prescribed and the effectiveness documented.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Chronic refractory depression patients who have been treated suboptimally with 2 or more antidepressants without significant improvement. I suggest ages 25-55 for ages, both genders.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Chronic refractory depression experiencing ongoing moderate to severe depression despite the administration of antidepressants.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Achieving control of chronic depression more quickly, with less wasted time and money spent on numerous ineffective antidepressants. Ultimately, much better control and treatment of chronic depression that is difficult to treat.

Describe any health-related risks, side effects, or harms that you are concerned about.

None known.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Depression and other mental health disorders

AHRQ Priority Populations

• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

None

Importance

Describe why this topic is important.

Chronic depression is debilitating, and often numerous medications are tried with varying success. Each trial on an antidepressant can take months, which is a waste of time and money while the victim suffers severe depression.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Discussions with psychiatrists about frustration in treating refractory depression and the time and money wasted in numerous medication trials, and the availability of genotypng as a possible solution to this issue.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Often treaters have no idea what antidepressant will work for any given patient and months or years can be spent in trials.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

When a patient is tested, the results will indicate to treaters the medications that are most likely to work well for that patient,.

Describe the timeframe in which an answer to your question is needed.

Unknown, possibly 2+ years

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

None known.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

When a patient is tested, the results will indicate to treaters the medications that are most likely to work well for that patient,.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program