CYP450 = cytochrome p450; SSRI = selective serotonin reuptake inhibitor
Numbers in this figure represent the research questions addressed in the systematic review:45
1 (overarching question): Does testing for cytochrome P450 (CYP450) polymorphisms in adults entering selective serotonin reuptake inhibitor (SSRI) treatment for non-psychotic depression lead to improvement in outcomes, or are testing results useful in medical, personal, or public health decisionmaking?
2: What is the analytic validity of tests that identify key CYP450 polymorphisms?
3a: How well do particular CYP450 genotypes predict metabolism of particular SSRIs? Do factors such as race/ethnicity, diet, or other medications, affect this association?
3b: How well does CYP450 testing predict drug efficacy? Do factors such as race/ethnicity, diet, or other medications, affect this association?
3c: How well does CYP450 testing predict adverse drug reactions? Do factors such as race/ethnicity, diet, or other medications, affect this association?
4a: Does CYP450 testing influence depression management decisions by patients and providers in ways that could improve or worsen outcomes?
4b: Does the identification of the CYP450 genotypes in adults entering SSRI treatment for non-psychotic depression lead to improved clinical outcomes compared to not testing?
4c: Are the testing results useful in medical, personal or public health decisionmaking?
5: What are the harms associated with testing for CYP450 polymorphisms and subsequent management options?