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Pharmacogenetics of antidepressants

Published on October 31, 2024   51 min

A selection of talks on Neuroscience

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0:00
My name is Alessandro Serretti and I am a Professor of Psychiatry at Kore University of Enna, Italy, and that this presentation will be about pharmacogenetics of antidepressants.
0:15
Why we need pharmacogenetics or antidepressants? Well, as a clinician, I can tell you that it is quite difficult to treat patients with depression because at present we have to work in a recursive, in a trial and error procedure, because usually, the first antidepressant that we use is not useful for all the patients. Typically, one-third of the patients respond quite well to the first antidepressant that we use, but two-thirds don't respond well. Of this half are responding to further treatments and then we have one-third of patients that are non-responders, the so called treatment-resistant depression. The other problem and difficulty is that the antidepressants that we use in our everyday clinical practice are indeed quite as slow in their action. We need at least 2, 3, sometime four weeks or even more before seeing the effect of the treatment that we are administering. So it's clear also from the slide that we are starting from the first antidepressant in case of people with depression that is being treated for depression and that can be chosen a wide range of antidepressants at present in many markets worldwide, we have more than 40 antidepressants. Usually the clinician chooses one that is supposedly the best for the patient and then waits, or increases the dose if needed to see if the treatment is tolerated or not, and then it happens as I told before that two-thirds of patients indeed do not show an adequate response to the first treatment. Therefore, for non-response or poor tolerability, we have to switch to a second antidepressant. Again, wait for 2, 3, 4 weeks until we see the outcome. Sometime it is needed to change 2, 3, 4 antidepressants or make combination or augmentations or potentiations to achieve a satisfactory result. Of course, this is clear that the current practice from a clinical perspective is far from ideal, and this is exactly the role of genetics, so called pharmacogenetics or antidepressants, that is the final aim to predict on the basis of the genetic background of the subject, which will be the best treatment for every patient. Instead of trying 1, 2, 3, 4 antidepressant and maybe the fifth antidepressant is the one that is effective.

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