title: Number of risk genotypes is a risk factor for major depressive disorder: a case control study.
abstract: BACKGROUND
  The objective of the study was to determine the genetic basis of Major Depressive Disorder, and the capacity to respond to antidepressant treatment. An association study of 21 candidate polymorphisms relevant to monoamine function and the mechanism of antidepressant response was conducted in 3 phenotypically distinct samples: a group with chronic or recurrent depression unable to respond to antidepressants (non-responders) (n = 58), a group capable of symptomatic improvement with or without treatment (responders) (n = 39), and volunteer controls (n = 85). The responders and non-responders constituted a larger group of depressed subjects.
  
  
  METHODS
  A candidate gene approach was employed to asses the genetics basis of Major Depressive Disorder. The genotypic frequencies of selected polymorphisms were compared between the controls and depressed subjects. To asses the genetics basis of the capacity to respond to antidepressant treatment, the responders were compared to the non-responders. Candidate genes were chosen based on functional studies and proximity to whole genome linkage findings in the literature. Risk genotypes were identified by previous functional studies and association studies.
  
  
  RESULTS
  A statistically significant difference in genotype frequency for the SLC6A4 intron 2 VNTR was detected between the subjects with a history of depression and controls (p = 0.004). Surprisingly, a statistically significant difference was detected between responders and non-responders for the DRD4 exon III VNTR genotype frequencies (p = 0.009). Furthermore, a difference between the controls and depressed subjects as well as between the controls and non-responders was detected for the number and distribution of risk genotypes in each group.
  
  
  CONCLUSIONS
  An association between several monoamine-related genes and Major Depressive Disorder is supported. The data suggest that the two depressive phenotypes are genetically different, inferring that the genetic basis for the capacity to respond to standard antidepressant treatment, and the genetic susceptibility to Major Depressive Disorder may be independent. In addition, a proof of concept is provided demonstrating that the number of risk genotypes may be an indication of susceptibility of major depressive disorder and the severity of the disorder.
authors.affiliation: Interdisciplinary Program in Genetics, Department of Psychiatry, University of Arizona, Tucson, AZ, USA.
authors.forename: Holly A
authors.initials: HA
authors.lastname: Garriock
authors.forename: Pedro
authors.initials: P
authors.lastname: Delgado
authors.forename: Mitchel A
authors.initials: MA
authors.lastname: Kling
authors.forename: Linda L
authors.initials: LL
authors.lastname: Carpenter
authors.forename: Michael
authors.initials: M
authors.lastname: Burke
authors.forename: William J
authors.initials: WJ
authors.lastname: Burke
authors.forename: Thomas
authors.initials: T
authors.lastname: Schwartz
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Marangell
authors.forename: Mustafa
authors.initials: M
authors.lastname: Husain
authors.forename: Robert P
authors.initials: RP
authors.lastname: Erickson
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Moreno