CLINICAL AND THERAPEUTIC ASSESSMENT OF TREATMENT-RESISTANT DEPRESSION AFTER GENE VARIATION TESTING

Abstract

The mail objective of this study is to identificate the variations in 5 genes, of which 3 are pharmacokinetic (CYP2B6, CYP2C19, CYP2D6) and 2 pharmacodynamic (SLC6A4, HTRA2), used to optimize therapy in patients with treatment-resistant depression (TRD) using pharmacogenomic testing (PGx) and monitoring clinical evolution by using the psychometric scales HAM-D and CGI-S in the initial stage (T1) and later HAM-D at 1 month (T2), 3 months (T3), 6 months (T4) and 12 months (T5). Depressive disorder is a public health problem because this pathology has a high tendency of recurrence, is the second cause of disability worldwide and has high costs. The depressive episode causes suffering to both the person and the family and relatives. In this longitudinal prospective study, we included 128 patients from the outpatient clinic of the PsihoNeuroMag Clinic in Oradea, Romania, diagnosed with TRD. The two groups presented during the research, were compared in the pretest stage (T1) as well as in the posttest stage according to the genetic testing using the t-test for independent samples. The onset age of the patients in the pharmacogenomic testing group is younger, but significant differences were indicated in the case of gender, the environment of origin and the number of recorded relapses. CYP2B6 gene analysis indicates relevant data in TRD course change between the HAM-D testing phase (between TI and T5). When CYP2B6 is at a low level, the class of drugs was most frequently changed and neuroleptics or thymostabilizers were associated and thus improvements were obtained between the baseline and the HAM-D evaluation at 12 months.