‘Convenient’ Biomarker May Predict Antidepressant Response

‘Convenient’ Biomarker May Predict Antidepressant Response
0 15 diciembre, 2014

Investigators at Dalhousie University in Halifax, Canada, found that CRP, an “easily accessible biomarker of systemic inflammation,” predicted response to the antidepressants escitalopram (Lexapro, Forest Laboratories, Inc) and nortriptyline. “While there have been other biomarkers identified [to predict response to antidepressants], CRP has the major advantage of being ‘differential’ ― it predicts response to one drug in one direction and response to an alternative drug in the opposite direction,” lead author Rudolf Uher, MD, PhD, told Medscape Medical News. Low CRP, Better Response . With previous evidence showing an association between systemic inflammation and depression, the researchers wanted to investigate the hypothesis that a similar relationship might exist between CRP and response to treatment for depression, using the 2 different antidepressants ― escitalopram, a selective serotonin reuptake inhibitor, and nortriptyline, a selective norepinephrine reuptake inhibitor. The study involved 241 adults with major depressive disorder who were enrolled in the Genome-Based Therapeutic Drugs for Depression (GENDEP) study, a multicenter, randomized clinical trial. Patients were randomly assigned to receive 12 weeks of treatment with escitalopram (N = 115) or nortriptyline (N = 126), and their CRP levels were measured at baseline. Patients with low levels of CRP (<1 mg/L) had better response to escitalopram, with Montgomery-Åsberg Depression Rating Scale (MADRS) scores, assessed weekly, that were 3 points higher than those with low CRP levels who were taking nortriptyline. Meanwhile, patients with higher CRP levels had an opposite response, with MADRS scores that were 3 points higher with nortriptyline than with escitalopram. “It remains to be investigated whether other antidepressants with similar effects on the immune system can substitute for nortriptyline in patients with high levels of systemic inflammation.” The study nevertheless identifies “the strongest differential predictor of response to a serotonin reuptake inhibitor versus a norepinephrine reuptake inhibitor to date,” the authors write.

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