Abstract
Several pharmacogenetic-based decision support tools for psychoactive medication selection are available. However, the scientific evidence of the gene-drug pairs analyzed is mainly based on pharmacogenetic studies in patients with major depression or schizophrenia, and their clinical utility is mostly assessed in major depression. This study aimed at evaluating the impact of individual genes, with pharmacogenetic relevance in other psychiatric conditions, in the response to treatment in bipolar depression. Seventy-six patients diagnosed with bipolar disorder and an index major depressive episode were included in an observational retrospective study. Sociodemographic and clinical data were collected, and all patients were genotyped using a commercial multigene pharmacogenomic-based tool (Neuropharmagen®, AB-Biotics S.A., Barcelona, Spain). Multiple linear regression was used to identify pharmacogenetic and clinical predictors of efficacy and tolerability of medications. The pharmacogenetic variables response to serotonin-norepinephrine reuptake inhibitors (SNRIs) (ABCB1) and reduced metabolism of quetiapine (CYP3A4) predicted patient response to these medications, respectively. ABCB1 was also linked to the tolerability of SNRIs. An mTOR-related multigenic predictor was also associated with a lower number of adverse effects when including switch and autolytical ideation. Our results suggest that the predictors identified could be useful to guide the pharmacological treatment in bipolar disorder. Additional clinical studies are necessary to confirm these findings.
Highlights
Bipolar disorder (BD) is a complex and severe psychiatric condition characterized by biphasic mood episodes of mania or hypomania and depression, which are expressed as recurrent episodes of changes in energy levels and behavior that last from days to weeks, each with subsyndromal symptoms commonly present between major episodes [1]
Seventy-six patients diagnosed with bipolar disorder and an index major depressive episode were included in an observational retrospective study
All patients had a diagnosis of BD with an index episode of major depression
Summary
Bipolar disorder (BD) is a complex and severe psychiatric condition characterized by biphasic mood episodes of mania or hypomania and depression, which are expressed as recurrent episodes of changes in energy levels and behavior that last from days to weeks, each with subsyndromal symptoms commonly present between major episodes [1]. The total lifetime prevalence of BD is approximately 2.4% [2]. Despite an apparent lower prevalence than unipolar depression [3], BD is associated with higher levels of functional impairment and compromised quality of life, posing a greater socioeconomic burden [4]. Due to the progressive and debilitating course of this disorder, an early and effective therapeutic approach is key for patient prognosis [8,9]
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