Fan Mikayla, Bousman Chad A
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Departments of Medical Genetics, Psychiatry, Physiology & Pharmacology, University of Calgary, Calgary, Alberta, Canada.
Mol Neuropsychiatry. 2020 Apr;5(Suppl 1):27-33. doi: 10.1159/000504253. Epub 2019 Nov 26.
The Sequenced Treatment Alternatives to Relieve Depression (STARD) algorithm is the most recognized protocol-based care approach for moderate to severe depression. However, its implementation results in one-third of individuals receiving modest to no symptom remission. One possible explanation is the inter-individual differences in antidepressant metabolism due to and genetic variation. Here, we aimed to determine the potential benefit of pairing and testing with the five-step STARD algorithm. To estimate the proportion of individuals that could benefit from and testing, we simulated the STARD algorithm using ethnicity-specific phenotype (e.g., metabolizer status) frequencies published by the Clinical Pharmacogenetics Implementation Consortium and census data from the Canada and the US. We found that up to one-third of the US and Canadian populations being treated for depression could benefit from the addition of and genetic testing. The potential benefit varied for each step of the algorithm and for each province, territory, and state. genotyping had the greatest potential impact within the first two steps of the algorithm, while genotyping had the most notable impact in Steps 3, 4, and 5. Our findings suggest the implementation of and genetic testing alongside the STARD treatment algorithm may improve depression treatment outcomes in Canada and the US.
缓解抑郁症的序贯治疗方案（STARD）算法是针对中度至重度抑郁症最受认可的基于方案的护理方法。然而，其实施结果是三分之一的个体症状缓解程度一般或没有缓解。一个可能的解释是由于[此处可能缺失具体内容]和基因变异导致的个体间抗抑郁药代谢差异。在此，我们旨在确定将[此处可能缺失具体内容]检测与五步STARD算法相结合的潜在益处。为了估计可从[此处可能缺失具体内容]检测中获益的个体比例，我们使用临床药物基因组学实施联盟公布的特定种族表型（如代谢状态）频率以及加拿大和美国的人口普查数据模拟了STARD算法。我们发现，接受抑郁症治疗的美国和加拿大人群中，高达三分之一的人可从增加[此处可能缺失具体内容]基因检测中获益。算法的每一步以及每个省、地区和州的潜在益处各不相同。[此处可能缺失具体内容]基因分型在算法的前两步中具有最大的潜在影响，而[此处可能缺失具体内容]基因分型在第3、4和5步中影响最为显著。我们的研究结果表明，在STARD治疗算法的同时实施[此处可能缺失具体内容]基因检测可能会改善加拿大和美国的抑郁症治疗效果。
