Cytochrome P450 2C19 poor metabolizer phenotype in treatment resistant depression: Treatment and diagnostic implications

Marin Veldic*, Ahmed T. Ahmed, Caren J. Blacker, Jennifer R. Geske, Joanna M. Biernacka, Kristin L. Borreggine, Katherine M. Moore, Miguel L. Prieto, Jennifer L. Vande Voort, Paul E. Croarkin, Astrid A. Hoberg, Simon Kung, Renato D. Alarcon, Nicola Keeth, Balwinder Singh, William V. Bobo, Mark A. Frye

*Autor correspondiente de este trabajo

Producción científica: Contribución a una revistaArtículorevisión exhaustiva

10 Citas (Scopus)


Background: Pharmacogenomic testing, specifically for pharmacokinetic (PK) and pharmacodynamic (PD) genetic variation, may contribute to a better understanding of baseline genetic differences in patients seeking treatment for depression, which may further impact clinical antidepressant treatment recommendations. This study evaluated PK and PD genetic variation and the clinical use of such testing in treatment seeking patients with bipolar disorder (BP) and major depressive disorder (MDD) and history of multiple drug failures/treatment resistance. Methods: Consecutive depressed patients evaluated at the Mayo Clinic Depression Center over a 10-year study time frame (2003–2013) were included in this retrospective analysis. Diagnoses of BP or MDD were confirmed using a semi-structured diagnostic interview. Clinical rating scales included the Hamilton Rating Scale for Depression (HRSD24), Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Adverse Childhood Experiences (ACE) Questionnaire. Clinically selected patients underwent genotyping of cytochrome P450 CYP2D6/CYP2C19 and the serotonin transporter SLC6A4. PK and PD differences and whether clinicians incorporated test results in providing recommendations were compared between the two patient groups. Results: Of the 1795 patients, 167/523 (31.9%) with BP and 446/1272 (35.1%) with MDD were genotyped. Genotyped patients had significantly higher self-report measures of depression and anxiety compared to non-genotyped patients. There were significantly more CYP2C19 poor metabolizer (PM) phenotypes in BP (9.3%) vs. MDD patients (1.7%, p = 0.003); among participants with an S-allele, the rate of CYP2C19 PM phenotype was even higher in the BP (9.8%) vs. MDD (0.6%, p = 0.003). There was a significant difference in the distribution of SLC6A4 genotypes between BP (l/l = 28.1%, s/l = 59.3%, s/s = 12.6%) and MDD (l/l = 31.4%, s/l = 46.1%, s/s = 22.7%) patients (p < 0.01). Conclusion: There may be underlying pharmacogenomic differences in treatment seeking depressed patients that potentially have impact on serum levels of CYP2C19 metabolized antidepressants (i.e., citalopram / escitalopram) contributing to rates of efficacy vs. side effect burden with additional potential risk of antidepressant response vs. induced mania. The evidence for utilizing pharmacogenomics-guided therapy in MDD and BP is still developing with a much needed focus on drug safety, side effect burden, and treatment adherence.
Idioma originalInglés
Número de artículo83
PublicaciónFrontiers in Pharmacology
EstadoPublicada - 2019

Nota bibliográfica

Publisher Copyright:
Copyright © 2019 Veldic, Ahmed, Blacker, Geske, Biernacka, Borreggine, Moore, Prieto, Vande Voort, Croarkin, Hoberg, Kung, Alarcon, Keeth, Singh, Bobo and Frye. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Palabras clave

  • Bipolar disorder
  • CYP2C19
  • Cytochrome P450
  • Pharmacogenomics
  • SLC6A4


Profundice en los temas de investigación de 'Cytochrome P450 2C19 poor metabolizer phenotype in treatment resistant depression: Treatment and diagnostic implications'. En conjunto forman una huella única.

Citar esto