The role of clinical variables, neuropsychological performance and SLC6A4 and COMT gene polymorphisms on the prediction of early response to fluoxetine in major depressive disorder.
BACKGROUND
Major depressive disorder (MDD) is treated with antidepressants, but only between 50% and 70% of the patients respond to the initial treatment. Several authors suggested different factors that could predict antidepressant response, including clinical, psychophysiological, neuropsychological, neuroimaging, and genetic variables. However, these different predictors present poor prognostic sensitivity and specificity by themselves. The aim of our work is to study the possible role of clinical variables, neuropsychological performance, and the 5HTTLPR, rs25531, and val108/58Met COMT polymorphisms in the prediction of the response to fluoxetine after 4weeks of treatment in a sample of patient with MDD.


METHODS
64 patients with MDD were genotyped according to the above-mentioned polymorphisms, and were clinically and neuropsychologically assessed before a 4-week fluoxetine treatment. Fluoxetine response was assessed by using the Hamilton Depression Rating Scale. We carried out a binary logistic regression model for the potential predictive variables.


RESULTS
Out of the clinical variables studied, only the number of anxiety disorders comorbid with MDD have predicted a poor response to the treatment. A combination of a good performance in variables of attention and low performance in planning could predict a good response to fluoxetine in patients with MDD. None of the genetic variables studied had predictive value in our model.


CONCLUSIONS
The possible placebo effect has not been controlled. Our study is focused on response prediction but not in remission prediction.


CONCLUSIONS
Our work suggests that the combination of the number of comorbid anxiety disorders, an attentional variable, and two planning variables makes it possible to correctly classify 82% of the depressed patients who responded to the treatment with fluoxetine, and 74% of the patients who did not respond to that treatment.
Gudayol-Ferré
Esteve
E
Clínica de Enfermedades Crónicas y Procedimientos Especiales CECYPE, Morelia, Mich., Mexico. ferre@zeus.umich.mx
Herrera-Guzmán
Ixchel
I
Camarena
Beatriz
B
Cortés-Penagos
Carlos
C
Herrera-Abarca
Jorge E
JE
Martínez-Medina
Patricia
P
Cruz
David
D
Hernández
Sandra
S
Genis
Alma
A
Carrillo-Guerrero
Mariana Y
MY
Avilés Reyes
Rubén
R
Guàrdia-Olmos
Joan
J
D000328:Adult; D000483:Alleles; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics / Q000523:psychology; D001288:Attention / Q000187:drug effects; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics* / Q000523:psychology; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use*; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D010555:Personality Inventory; D011110:Polymorphism, Genetic / Q000235:genetics*; D011379:Prognosis
D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine