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- Title
Genotyping as a step towards personalized approach in psychiatry: treating a therapy resistant patient.
- Authors
Petrykiv, S.; Arts, M.; De Jonge, L.
- Abstract
Introduction: Amount of first-line antidepressants (AD) with different pharmacodynamic properties is constantly increasing. Recent meta-analyses, however, have shown no difference in effectiveness between them. The conclusion are based though on comparison of average differences rather than assessing interindividual variability. Genotyping offers an unique opportunity to choose individually the most appropriate drug for patients with depressive disorder. Objectives: Discussion on genotyping and its implication for the choice of the most effective AD-medication. Methods: Case rapport of a poor responding patient with depression who has been successfully treated for her symptoms after an appropriate AD-switch made based on the results of genotyping. Results: A 50 y.o. female with moderate depression received subsequently treatment with citalopram 20 mg 1dd1, sertraline 50 mg 1dd1 (both were stopped due to unsustainable side effects) and fluoxetine (stopped due lack of effectiveness). Genotyping showed a poor rate of metabolism in CYP2D6 and intermediate metabolism in CYP3A4, 2C19 and 1A2 iso-enzymes. Therefore, we chose for a low dose of Venlafaxine, where the parent compound is even active as its metabolite. Depressive symptoms resolved within four weeks of treatment without side effects. Conclusions: Between individual differences in treatment response depend on multiple patient- and drug-related factors. An average treatment effect, used by the most studies, is unsuitable to explain inter-individual differences, mainly in 30% of non- and poor responding subjects. Tools of individualized medicine are therefore urgently needed. As the prevalence of CYP polymorphisms is high (10%), genotyping can be actively used to choose the right AD and in de optimal dose.
- Subjects
DEPRESSION in women; MENTAL depression; INDIVIDUALIZED medicine; PSYCHIATRY
- Publication
European Psychiatry, 2020, Vol 63, pS215
- ISSN
0924-9338
- Publication type
Article