hardpharmacogenomicsCYP2D6CYP2C19antidepressantpoor metabolizerprecision medicine
A 38-year-old woman with major depressive disorder has experienced intolerable side effects with two prior SSRI trials. She developed severe nausea, activation, and insomnia on sertraline 50 mg and experienced significant weight gain and sexual dysfunction on paroxetine 20 mg, leading to discontinuation of both medications within six weeks. She now presents requesting pharmacogenomic testing to guide treatment selection. Testing reveals that she is a CYP2D6 poor metabolizer and a CYP2C19 rapid metabolizer. Her current PHQ-9 score is 17, and she has no comorbid medical conditions, no substance use, and no suicidal ideation. The PMHNP is using these results to inform the treatment plan. Which of the following best reflects appropriate pharmacogenomic-guided treatment planning?