The pharmacogenomics of depression: mapping the social and ethical impact

Depressive disorders are a focus of growing social and economic concern. While antidepressant medications are widely accepted, they are ineffective for nearly 40% of users, and cause numerous adverse drug reactions. The pharmacogenomics of depression attempts to better understand the role of genetic variation in antidepressant metabolism in the hope of improving drug efficacy and tolerability. However, the development and delivery of genome-based antidepressants face many hurdles. In this paper we provide an overview of the potential impact of the pharmacogenomics of depression on public mental health care by focusing on the social and ethical issues at stake. These include questions about genetic testing, informed consent, drug access, and market fragmentation. We end the paper with a brief discussion of the wider context and how the pharmacogenomics of depression relates to broader trends in psychiatry and biomedicine.