Finding the right antidepressant quickly

Primary care researchers from the University of Melbourne are investigating whether a simple DNA test might help general practitioners (GPs) and patients fast-track their search for the most effective drug treatment for depression.

In Australia, most patients diagnosed with depression are managed in primary care settings and almost 90 per cent of antidepressants are prescribed by GPs. Unfortunately, it may take years of care to find the right antidepressant and dosage to improve a patient’s mental health symptoms. This leads to prolonged symptoms, adverse side effects and expensive medical costs. The pursuit of the right antidepressant may endure for decades in underserved communities, including regional and remote areas.

Better management of depression in primary care is necessary. The PhaRmacogEnomicS In Depression (PRESIDE) Trial is investigating whether prescribing antidepressants based on patients’ DNA can improve depression outcomes. Participants with depressive symptoms take a DNA test, while participating GPs receive guidance about using this DNA test for prescribing decisions with patients. Recruitment is ongoing throughout Victoria.

This trial is based on research showing that the same antidepressant can have very different effects between people due to differences in DNA and drug metabolism. Current evidence for this DNA test is promising; other countries have implemented guidelines around the use of a patient’s genetic information to inform antidepressant selection and dosage. Recognising the potential of DNA-informed treatment for depression in general practice, the Medical Research Future Fund supported the launch of this randomised clinical trial last year.

If PRESIDE demonstrates this DNA test is cost-effective in assisting GPs and patients with choosing a suitable antidepressant, this evidence could contribute to a change in Australia’s Therapeutic Guidelines. The DNA test may be placed on the Medicare Benefits Scheme, allowing all Australians to access better-targeted treatment for depression.

Researchers hope the ongoing study will impact general practice and reduce mental health inequity between urban and rural Australia. Patients would gain faster access to the right antidepressant and experience quicker reduction in their depressive symptoms, requiring fewer healthcare visits. All general practice staff, including GPs, practice managers and nurses, are essential for the success of this study.

Several participants have shared their experiences:

‘It seemed like the next thing to do, you know, to use our genes to understand medical treatment, I think it was a good, an excellent initiative.’

‘I found it was quite professionally run.’

A researcher also shared their experience with regional recruitment:

‘It was great to meet a more diverse population in rural settings and provide cutting-edge research to a group of people who are often forgotten or under-represented in clinical research.’

The PARTNER Network

Access to clinical trials is limited in regional and rural Australia, and participation is uncommon. The PRESIDE trial is recruiting general practices from rural and regional areas to fully represent all parts of Victoria.

The PARTNER Network aims to support trials like PRESIDE. Led by the University of Melbourne, PARTNER is a collaboration between five universities and the Royal Flying Doctor Service, as part of the Australian Teletrial Program funded by the Medical Research Future Fund. The goal is to create a national network of 90 rural general practices, by 2025, using software to identify eligible patients for specific trials, making trial recruitment more efficient. The PARTNER Network will:

• connect rural Australians to clinical trials
• create research-ready rural GPs, to improve the speed and quality of research
• improve rural general practice skills and capacity for trial research
• identify and support trials for the rural landscape.

If you work in a rural general practice and are interested in participating in research, contact the PRESIDE trial at [email protected] or the PARTNER Network at [email protected].