Genetic testing provides information about how an individual metabolizes medication, but very limited information about how they might respond to a given medication. Medications are grouped as either “green,” “yellow,” or “red,” based on the degree of gene-drug interactions present [1]:
These color groups should be interpreted with caution. It is important to look at the associated notes when genetic testing is conducted to determine how an individual may metabolize a given medication based on their enzymatic profile.
The two largest randomized control trials of pharmacogenetic testing in relation to psychopharmacology (GUIDED trial in 2019 and PRIME Care trial in 2022) evaluated a total of ~3,000 participants with Major Depressive Disorder and found no difference in symptom remission in patients whose medication choices were guided by genetic testing [3, 4]. Additionally, genetic testing can be cost-prohibitive, frequently costing patients with commercial insurance or a Medicare Advantage plan between $300–350.
The American Academy of Child and Adolescent Psychiatry released a policy statement on pharmacogenetic tests approved in 2020 as follows:
Clinical Use of Pharmacogenetic Tests in Prescribing Psychotropic Medications for Children and Adolescents
Background
Several commercially available combinatorial pharmacogenomic tests are being marketed for psychiatric clinical practice. Commercial entities claim that the testing measures drug metabolism to guide medication choice and dosing to impact therapeutic response and side effects.
In October 2018, the Food and Drug Administration (FDA) issued a safety communication warning against the use of genetic tests with unapproved claims to predict medication response. The FDA stated that changing a patient’s medication regimen based on the results of a pharmacogenomic test leads to “inappropriate treatment decisions and potentially serious health consequences for the patient.”
Only a small fraction of the available commercial products have undergone randomized controlled trials in adults only.
Current studies are limited by:
Additionally, numerous factors affect medication response unaccounted for by genetic variation. Genetic variations are managed clinically with slow and thoughtful medication management.
Furthermore, pharmacogenomic testing provides little meaningful information when two or more medications are used concurrently.
The American Academy of Child and Adolescent Psychiatry recommends:
As it currently stands, the American Academy of Child and Adolescent Psychiatry (AACAP) and the American Academy of Family Physicians (AAFP) both do not recommend genetic testing as a primary guide for pharmacological treatment for mental health disorders [1,5].
Abrams G, Malas N, Patel P. Pharmacogenetic Testing. Michigan Clinical Consultation & Care. November 4, 2025. https://mc3michigan.org/clinical-pearls-faqs-pharmacogenetic-testing/.