This is a prospective, randomized clinical trial to investigate the clinical impact of a preemptive pharmacogenomics strategy to guide antidepressant therapy in cancer patients. Those enrolled onto the clinical trial will be randomized to either DNA-guided choice of therapy or clinical management alone. Scores on self-reported measures of depressive and anxiety symptoms along with quality of life will be compared between cohorts.

Inclusion Criteria:

• Patients with a cancer diagnosis
• Be 18 years of age or older
• Patients who rate depression or anxiety > 5 based on a 10 point scale
• Patients expected to live greater than 6 months
• Serum bilirubin and creatinine < 1.5x upper limit of normal
• AST and ALT < 3 times upper limit of normal
• Willing and able to provide written informed consent
• Able to complete self-assessment questionnaires

Exclusion Criteria:

• Patients not diagnosed with cancer
• Antidepressant prescribing performed by a non-Moffitt psychiatrist after enrollment onto the clinical trial
• Known Pregnancy
• History of liver or allogenic stem cell transplant
• Patients with a known cognitive impairment (e.g., delirium, dementia, etc.) or psychological impairment (e.g., schizophrenia, bipolar disease, etc.) other than depressive and anxiety symptoms.

Patients will be blinded to the genomic results for 12 weeks, with the 12 week time period starting at the time of antidepressant drug prescribing.