Major depressive disorder (MDD) in older people is a relatively common, yet hard to treat problem. In this study we aimed to establish if a single nucleotide polymorphism in the 5- HT1A receptor gene (rs6295) determines antidepressant response in patients aged >80years (the oldest old) with MDD. 35Nineteen patients ≥80 years-old, with a new diagnosis of MDD were monitored for response to citalopram 20 mg daily over 4-weeks, and genotyped for the rs6295 allele. Both a frequentist and Bayesian analysis was performed on the data. Bayesian analysis answered the clinically relevant question: ‘what is the probability that an older patient would enter remission after commencing SSRI treatment, conditional on their rs6295 genotype?’. Individuals with a CC genotype showed a significant improvement in their Geriatric Depression Score (p=0.020) and cognition (p=0.035) compared to other genotypes. From a Bayesian perspective, we updated reports of antidepressant efficacy in older people with our data and calculated that the 4-week relative risk of entering remission, given a CC genotype, is 1.9 (95% HDI 0.7-3.5), compared to 0.52 (95% HDI 0.1-1.0) for the CG genotype. The sample size of n=19 is too small to draw any firm conclusions, however, the data suggest a trend indicative of a relationship between the rs6295 genotype and response to citalopram in older patients, which requires further investigation.
Bibliographical noteDoes the 5-HT1A rs6295 polymorphism influence the safety and efficacy of citalopram therapy in the oldest old? Greg Scutt, Andrew Overall, Railton Scott, Bhavik Patel, Lamia Hachoumi, Mark Yeoman, and Juliet Wright Therapeutic Advances in Drug Safety . Copyright © 2018 The Author(s). Reprinted by permission of SAGE Publications.
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- School of Pharmacy and Biomolecular Sci - Clinical Principal Lecturer
- Medicines Optimisation Research and Enterprise Group