Grant: Project Grant

Despite the availability of numerous antidepressants, many patients do not respond well to these medications and are labelled with "treatment-resistant" depression (TRD) or difficult-to-treat depression (DTTD) and require alternative interventions. TRD/DTTD remains poorly understood, however, it has been shown that a patient's genetic make-up can be associated with response and tolerability of antidepressant medications. Our group has contributed substantially to the studies in psychiatric pharmacogenetics (PGx), and we have acquired expertise in its clinical implementation. One of our main observation has been that treatment failure often resulted from misaligning medications with patients' genetic profiles. As such, we are compelled to expand on our research and understand genetic risk for TRD using state-of-the-art genetic and bioinformatic research tools. We will work collaboratively with the CAMH Major Depressive Disorder Integrated Care Pathway (MDD-ICP), a clinical program, that optimizes treatment by adopting measurement-based guided treatment. Our aim is to recruit and genotype 400 participants to identify genetic and non-genetic risk factors for TRD. Given CAMH's already-existing MDD-ICP infrastructure, the burden of TRD, and the relatively high incidence of TRD, the proposed project will move us closer towards treatment optimization and consequently towards reducing the disability associated with treatment failure. The proposed work is critical to support the large-scale integration of PGx testing into psychiatric practice in Canada.