U.S. student pharmacists perspectives on the pharmacogenomics of escitalopram and aripiprazole

Major depressive disorder (MDD) remains a significant illness worldwide, yet antidepressant therapy often follows an empirical "trial-and-error" approach. Escitalopram, a selective serotonin reuptake inhibitor is approved for MDD and generalized anxiety disorders, while aripiprazole (ARI), an atypical antipsychotic, is used as adjunctive therapy in treatment-resistant depression. Despite the broad availability of these agents, outcomes remain suboptimal. Data from the STAR*D trial indicate that only one-third of patients achieve remission after their first antidepressant trial, with many requiring multiple adjustments. This reactive approach prolongs symptom burden, increases adverse effects, and delays effective treatment.Advances in pharmacogenomics now offer a means to individualize therapy by identifying genetic polymorphisms - such as those found in CYP2C19 and CYP2D6-that influence escitalopram and aripiprazole metabolism and response. This literature review examines the evidence linking pharmacogenomic variability to antidepressant outcomes and explores how implementing genetic-guided prescribing can improve efficacy, reduce adverse effects, and enhance the pharmacists' role in mental health care.