Department of Psychiatry and Behavioural Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
Psychiatr Q. 2023 Sep;94(3):435-447. doi: 10.1007/s11126-023-10044-9. Epub 2023 Jul 25.
Major depression is a frequent condition which variably responds to treatment. In view of its high prevalence, the presence of treatment resistance in major depression significantly impacts on quality of life. Tailoring pharmacological treatment based on genetic polymorphisms is a current trend to personalizing pharmacological treatment in patients with major depressive disorders. Current guidelines for the use of genetic tests in major depression issued by the Clinical Pharmacogenomics Implementation Consortium (CPIC) are based on CYP2D6 and CYP2C19 polymorphisms which constitute the strongest evidence for pharmacogenomic guided treatment. There is evidence of increased clinical response to pharmacological treatment in major depression although largely in non-treatment resistant patients from Western countries. In this study, well characterised participants (N = 15) with complex, largely treatment resistant unipolar major depression were investigated, and clinical improvement was measured at baseline and at week-8 after the pharmacogenomics-guided treatment with the Montgomery Åsberg Depression Rating Scale (MÅDRS). Results suggested a statistically significant improvement (p = 0.01) of 16% at endpoint in the whole group and a larger effect in case of changes in medication regime (28%, p = 0.004). This small but appreciable effect can be understood in the context of the level of treatment resistance in the group. To our knowledge, this is the first study from the Middle East demonstrating the feasibility of this approach in the treatment of complex major depressive disorders.
重度抑郁症是一种常见的疾病，其治疗效果各不相同。鉴于其高发病率，重度抑郁症的治疗抵抗显著影响生活质量。根据遗传多态性来定制药物治疗是目前将药物治疗个性化的趋势，适用于重度抑郁障碍患者。目前，临床药物基因组学实施联盟（CPIC）发布的重度抑郁症使用遗传检测的指南基于 CYP2D6 和 CYP2C19 多态性，这些多态性构成了药物基因组指导治疗的最强证据。有证据表明，在重度抑郁症患者中，药物治疗的临床反应有所增加，尽管主要来自西方国家的非治疗抵抗患者。在这项研究中，对特征明确的参与者（N=15）进行了研究，这些参与者患有复杂的、主要治疗抵抗的单相重度抑郁症，并使用蒙哥马利抑郁评定量表（MÅDRS）在基线和药物基因组指导治疗 8 周后测量临床改善情况。结果表明，整个组在终点时的统计学显著改善（p=0.01）为 16%，而在改变药物治疗方案时（28%，p=0.004）效果更大。在该组的治疗抵抗水平背景下，可以理解这种小但明显的效果。据我们所知，这是中东地区首例证明这种方法在复杂重度抑郁障碍治疗中的可行性的研究。
