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for the therapeutic effects of antidepressants, a new antidepressant pharmacother-
apy could be developed to activate that system more acutely.
Pharmacogenomic approaches could help in predicting some of these outcomes.
Enzymes that metabolize antidepressants are shown in Table 13.2.
A 5-HT 6 receptor polymorphism (C267T) is associated with treatment response
to antidepressant treatment in MDD. A pharmacogenomic approach to individualize
antidepressant drug treatment is based on three levels:
- Identifying and validating the candidate genes involved in drug-response
- Providing therapeutic guidelines
- Developing a pharmacogenetic test-system for bedside-genotyping.
Biomarkers of Response to Antidepressant Treatment
The most promising biomarkers for response to antidepressant therapy include
genetic variants and gene expression profi les, proteomic and metabolomic markers,
neuroendocrine function tests, electrophysiology and brain imaging. Incorporation
of biomarkers in the treatment of MDD could help improve the effi ciency of treat-
ment trials and ultimately speed remission (Breitenstein et al. 2014 ). Biomarkers of
response to antidepressant treatment are shown in Table 13.3.
EEG to Predict Adverse Effects and Evaluate Antidepressant Effi cacy
Changes in brain activity prior to treatment with antidepressants can fl ag patient vul-
nerability. Quantitative electroencephalography (qEEG) measures revealed that
changes in brain function in the prefrontal region during the 1-week placebo lead-in
were related to side effects in subjects who received an antidepressant (Hunter et al.
2005 ). This study is the fi rst to link brain function and medication side effects, and to
Table 13.2 Enzymes that metabolize antidepressantsDrug CYP2D6 CYP2C19 CYP3A4 CYP1A2
Amitripyline + + + +
Nortriptyline +
Imipramine + + + +
Desipramine +
Clomipramine + + + +
Citalopram + +
Fluoxetine +
Fluvoxamine + +
Moclobemid +
Paroxetine +
Sertraline +
Venlafaxine + +
© Jain PharmaBiotech
13 Personalized Management of Psychiatric Disorders