Cytochrome P450 genotyping and antidepressants

doi:10.1136/bmj.39169.547512.80

BMJ 2007;334:759 (14 April), doi:10.1136/bmj.39169.547512.80

Editorials

Cytochrome P450 genotyping and antidepressants

An imperfect measure of a modest predictor of response to antidepressantsmay not be ready for clinical application

The first 150 words of the full text of this article appear below.

Patients' responses to treatment with antidepressants vary greatly.The largest study on the effectiveness of antidepressants todate suggested that roughly one third of patients will recoverfully given a long enough trial, one third will improve substantially,and one third will fail to respond.¹ A subset in all three groupswill have adverse effects such as sexual dysfunction, insomnia,nausea, and weight gain. Side effects are rarely dangerous,but they cause many patients to discontinue treatment, oftenafter a single prescription.²

Similar concerns exist for many drugs, not just antidepressants.What makes antidepressants especially frustrating for cliniciansand patients is the lack of factors to predict how individualpatients will respond to a given treatment. We know that onethird of patients will have minimal improvement, but we havefew data to guide selection of alternative treatments. Indeed,while the psychiatric literature abounds with reports of clinicalpredictors, the . . . [Full text of this article]

Roy H Perlis, director of pharmacogenomics research

Depression and Bipolar Clinical and Research Programs, Center for Human Genetic Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA

rperlis@partners.org