Abstract
This study aims to explore the potential benefits of antidepressant drugs related to metabolic enzyme and drug-targeted genes, identify the optimal treatment of major depression, and provide a reference for individualized medication selection. A prospective randomized single-blind investigation was conducted for 8 weeks. A pharmacogenomic-based interpretive report was provided to the treating physician in the guided group. Patients in this group were informed that their medication selection was directed by DNA testing. In the unguided group, treatment was provided based on the clinical experience of the physician without the guidance of pharmacogenomic testing. Pharmacogenomic-based interpretive report was not provided to these patients until treatment completion. The 17-item Hamilton depression scale (HAMD-17), Hamilton anxiety scale, and treatment emergent symptom scale were used to assess the clinical efficacy and side effects at baseline and after 2, 4, and 8 weeks of treatment. Among the 80 initially enrolled patients with depression, 71 participated in the full data analysis sets and were designated into guided (31) and unguided (40) groups, respectively. No significant difference (P > 0.05) in HAMD-17 total scores, response and remission rates was found between the guided and unguided groups at the end of the treatment. The incidence rate of adverse reaction was 55.56% in guided group and 57.89% in the unguided group. Our study suggested that pharmacogenomic testing might not considerably improve the clinical efficiency and safety for the guided group.
Highlights
Major depressive disorder (MDD) is a common mental illness with high incidence and recurrence rate, which increases the risk of committing suicide and brings heavy economic burden to society
This study aims to explore the potential benefit of pharmacogenomic testing for the optimal treatment of MDD
They found a greater reduction of depression scores in the guided group compared with the unguided group at week 8 [30.8% vs. 18.2% in HAM-D17 and 31.2% vs. 7.2% in the Quick Inventory of Depressive Symptomatology–Clinician Rated (QIDS-C16)], and no statistically significant difference was found at weeks 2 and 4 (Hall-Flavin et al, 2012)
Summary
Major depressive disorder (MDD) is a common mental illness with high incidence and recurrence rate, which increases the risk of committing suicide and brings heavy economic burden to society. Appropriate and timely therapy can improve clinical remission rate and reduce disease burden. According to the Sequenced Treatment Alternatives to Relieve Depression (STAR∗D) study, approximately one-third of patients with MDD would respond to the first guideline-notified antidepressant (Trivedi et al, 2006; Gaynes et al, 2009). Patients’ response to psychotropic drugs, side effects, and doses of antidepressant drugs considerably varies depending on many factors, such as age, gender, diagnostic accuracy, potential drug interaction, nutritional status, genetics, and patient compliance. The variance in antidepressant responses is approximately 42% through common genetic variation (Tansey et al, 2013)
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