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Your frustration with the "trial and error" process is entirely valid, but doctors hesitate with pharmacogenomic (PGx) testing because it is not a "magic map" for psychiatric treatment. While PGx testing is an incredible tool, it has strict clinical limitations. It primarily analyzes how your liver enzymes (like the CYP450 system) metabolize a drug—meaning it can predict if a medication might cause higher side effects or process too quickly. However, it cannot predict efficacy. It cannot tell your doctor which drug will actually cure your depression or anxiety because it does not map out your brain’s complex neurochemistry or clinical history. Because these tests are highly expensive, not routinely recommended by global psychiatric guidelines as a first-line tool, and can provide a false sense of certainty, most clinicians rely on careful, symptom-targeted clinical evaluation instead.

Pharmacogenomic testing costs too high and still it can't predict response to drugs for sure, it can at max predict side effects and pharmacokinetics of drugs.

Hi

We are in a developing country. First of all it's a very expensive test. Secondly Psychiatry is still very complex and not all receptor profile or mechanisms have been well predicted. So the reliability of the test is very low. And it cannot predict how you are going to respond to the drug given. The trial and error method works better because there are clusters of symptoms and in real world practice rarely a fixed diagnosis is made. So based on the symptoms a drug is chosen and not just the diagnosis.

Its still under process,

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Hi, pharmacogenomics  strongest evidence in psychiatry currently relates to drug metabolism (pharmacokinetics) rather than reliably predicting treatment response (pharmacodynamics). That's one reason pharmacogenomics has not yet replaced careful clinical prescribing. "Think of pharmacogenomics as a helpful map, not a GPS. It can tell us which roads may be better or riskier, but it cannot yet tell us exactly which medication will work best for you. Your clinical response remains the most important guide."