Risk Phenotypes, Comorbidities, Pharmacotherapy, and
                    Electroconvulsive Therapy (ECT) in a Cohort with Difficult-to-Treat Depression
                    in Comparison to an Unmedicated Control Group

Hannah B. Maier; Anton Borchert; Alexandra Neyazi; Nicole Moschny; Rasmus Schülke; Gabriel L. Bundies; Thorsten Folsche; Anastasia Gaspert; Johanna Seifert; Stefan Bleich; Maike Scherf-Clavel; Stefan Unterecker; Jürgen Deckert; Helge Frieling; Heike Weber

doi:10.1055/a-2292-1438

Pharmacopsychiatry, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Pharmacopsychiatry 2024; 57(04): 191-203
DOI: 10.1055/a-2292-1438

Original Paper

Risk Phenotypes, Comorbidities, Pharmacotherapy, and Electroconvulsive Therapy (ECT) in a Cohort with Difficult-to-Treat Depression in Comparison to an Unmedicated Control Group

Authors

Hannah B. Maier

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
Anton Borchert

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
Alexandra Neyazi

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany

²Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Germany
Nicole Moschny

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
Rasmus Schülke

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
Gabriel L. Bundies

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
Thorsten Folsche

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
Anastasia Gaspert

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
Johanna Seifert

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
Stefan Bleich

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
Maike Scherf-Clavel

³Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany
Stefan Unterecker

³Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany
Jürgen Deckert

³Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany
Helge Frieling

¹Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
Heike Weber

³Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany

Abstract

Background Approximately 15–25% of depressed patients suffer from difficult-to-treat depression (DTD). Patients with DTD require a thorough examination to avoid the oversight of treatable (psychiatric/somatic) comorbidities or (pseudo-)resistance to antidepressant drugs (ADs). Polymorphisms of the cytochrome P450 (CYP) enzymes 2D6 and 2C19, which play a major role in the metabolism of ADs, may contribute to resistance to ADs. Patients with DTD might benefit from electroconvulsive therapy (ECT).

Methods We enrolled 109 patients with DTD and 29 untreated depressed controls (UDC). We assessed risk phenotypes, comorbidities, and treatment, including ECT. We also performed pharmacokinetic analyses of CYP2D6 and CYP2C19.

Results DTD patients significantly more often suffered from comorbid psychiatric diseases, especially ICD-10: F40-F48 (DTD:40.4%, UDC:17.2%, OR 11.87, p=0.011) than UDC patients. DTD patients receiving ECT were more likely to achieve remission (37.7% vs. 11.8%, OR=3.96, p=0.023). Treatment with ADs did not differ between remitters and non-remitters. No significant differences were observed in the distribution of CYP2D6 and CYP2C19 variants between both groups.

Conclusion Patients with DTD appear to experience comorbid neurotic stress and somatoform disorders (ICD-10: F40 – F48) more frequently. Therefore, a comprehensive differential diagnosis is crucial when patients do not respond sufficiently to antidepressant medication. Genotyping CYP2D6 and CYP2C19 should be considered.

Keywords

difficult-to-treat-depression - phenotyping - CYP enzymes - psychiatric comorbidities - pharmacogenetics - ECT

Volltext

Referenzen

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