In order to optimize the efficacy of drugs, nowadays the patient’s own gene variations are taken into account (personalized medicine). This is currently applied a lot within oncology but not within psychiatry.
The treatment outcome of antidepressants varies widely and many patients do not respond to treatment or receive side effects. In a new study, the most common antidepressant drug escitalopram has been studied in relation to genetic variation in the gene encoding the enzyme (CYP2C19) that metabolizes escitalopram.
It was found that one third of the 2,087 patients included in the study received too high or low plasma levels of the drug at standard dosage. In addition, it was seen that 30% of patients with genetic variants causing too high or low levels of enzyme discontinue escitalopram treatment and switch to other medicines within one year, while only 10-12% of patients with the common genotype switched medication. The study shows that genotyping of CYP2C19 would be of great clinical assistance to individualize the dose of escitalopram and other SSRI:s causing a more efficient antidepressant treatment.
Marin M. Jukic, Tore Haslemo, Espen Molden, Magnus Ingelman-Sundberg ”Impact of CYP2C19 Genotype on Escitalopram Exposure and Therapeutic Failure: A Retrospective Study Based on 2,087 Patients” The American Journal of Psychiatry, online 12 januari 2018, doi: 10.1176/appi.ajp.2017.17050550