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A New Way to Make Antidepressant Treatment Decisions?

a genetically guided treatment algorithm for depression improves outcomes in a pilot study.

Individual differences in drug metabolism and response hold promise for personalized medicine. In a pilot, prospective, open-label, nonrandomized trial, investigators examined whether an individualized pharmacogenetic algorithm that guided medication selection and monitoring would improve care. Genetic testing of DNA from buccal swabs was provided by a pharmacogenetics company with links to three authors.

All participants, consecutively selected patients with major depressive disorder, were genotyped for three cytochrome P450 (CYP) genes (CYP2D6, CYP2C19, and CYP1A2), which determine poor, intermediate, extensive, or ultrarapid metabolic capacity, and for the long and short forms of the serotonin transporter gene (SLC6A4) and a serotonin 2A receptor polymorphism (HTR2A T102C), which are associated with differential responses to antidepressants.

Data were analyzable on 44 patients, divided into two groups (each with 12 women and 10 men; mean age, 42). Patients had long treatment histories and were receiving psychotherapy. Clinicians treated the "unguided" group without the benefit of pharmacogenetic information. The guided group was treated by clinicians who were informed about their patients' pharmacogenetic profiles and who received algorithms advising individualized treatment strategies. These strategies advised clinicians to use each of 26 specific psychiatric medications as directed, with caution, or with caution and more frequent monitoring.

The two groups had similar scores at baseline and response profiles at weeks 2 and 4 on the Quick Inventory of Depressive Symptomatology, Clinician Rated, and the Hamilton Rating Scale for Depression. By week 8, the group treated with pharmacogenetic guidance showed significantly greater improvement.

Comment: These encouraging preliminary findings merit further study in randomized controlled clinical trials using larger samples. Future research should focus on multiple medication interactions and treatment resistance. Patients may eventually look forward to meaningfully improved outcomes achieved via individually tailored practice algorithms guided by pharmacogenetic testing, which is becoming increasingly less expensive.

— Joel Yager, MD

Published in Journal Watch Psychiatry November 9, 2012

Citation(s):

Hall-Flavin DK et al. Using a pharmacogenomic algorithm to guide the treatment of depression. Transl Psychiatry 2012 Oct 16; 2:e172. (http://dx.doi.org/10.1038/tp.2012.99)

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• Genetically guided algorhytm-comments
  V.A.P. Ghorpade, Private practice, 5 Dec 2012 9:10 AM EST
  Specialty: Psychiatry
  Very good work for the present day in view of array of antidepressants available putting the psychiatrists in a confusion... [more]

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