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Matchar DB, Thakur ME, Grossman I, et al. Testing for Cytochrome P450 Polymorphisms in Adults With Non-Psychotic Depression Treated With Selective Serotonin Reuptake Inhibitors (SSRIs). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jan. (Evidence Reports/Technology Assessments, No. 146.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Testing for Cytochrome P450 Polymorphisms in Adults With Non-Psychotic Depression Treated With Selective Serotonin Reuptake Inhibitors (SSRIs)

Testing for Cytochrome P450 Polymorphisms in Adults With Non-Psychotic Depression Treated With Selective Serotonin Reuptake Inhibitors (SSRIs).

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6Conclusions

With pharmacogenetics and personalized medicine becoming everyday terms used in medicine, answering questions about the utility of genotyping as it relates to clinical practice has become vital. The practice of medicine in general and psychiatry in particular, involves many challenges, and as knowledge about the biological basis of diseases evolves, those diseases have to be redefined in the light of this new understanding; this redefinition, in turn, guides drug development for conditions such as depression. As we struggle to understand the different variables that influence response to antidepressant treatment, we need every answer that will take us closer to our goal of optimizing treatment for individual patients.

The evidence reviewed in this report demonstrates the high analytic sensitivity and specificity of tests for cytochrome P (CYP) genotyping, but for few of the known variants. The short list of papers addressing the key questions clearly demonstrates the lack of sufficient evidence for incorporation of any of these tests into guidelines for clinical practice. Moreover, the nature of most pharmacogenetic evidence is of rather low positive and negative predictive values, given the functional relevance of each variant and the genetic and biological context in which it is examined for each disease and drug scenario. As outlined in Chapter 5, there is a critical need to carry out research in ways that would help us answer as many questions as we can. We anticipate that the issue will not be one of safety, but rather one of decreasing morbidity and thereby improving quality of life in patients with non-psychotic depression. Considering the high prevalence of depressive disorders and the length of time required to determine whether a given antidepressant is successful or not, there may be a perceivable impact at the population level if even a small benefit can be demonstrated at the individual level.

Another reason for studying this question further is that as newer treatments for depression become available, the resolution of the question of CYP genotyping may help us apply the information to emerging treatments.

In conclusion, we recommend prospective studies of CYP450 genotyping in the treatment of non-psychotic depression with selective serotonin reuptake inhibitors (SSRIs) to examine the utility of such genotyping in clinical practice.

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