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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

Hannah B. Maier
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
,
Anton Borchert
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
,
Alexandra Neyazi
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
2   Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Germany
,
Nicole Moschny
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
,
Rasmus Schülke
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
,
Gabriel L. Bundies
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
,
Thorsten Folsche
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
,
Anastasia Gaspert
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
,
Johanna Seifert
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
,
Stefan Bleich
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
,
Maike Scherf-Clavel
3   Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany
,
Stefan Unterecker
3   Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany
,
Jürgen Deckert
3   Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany
,
Helge Frieling
1   Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Germany
,
Heike Weber
3   Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany
› Author Affiliations Funding This project was supported by the PRACTIS-Clinician Scientist Program of Hannover Medical School, funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation, ME3696/3–1) – Project-ID 413617135 and in-house funding from Hannover Medical School. The funding agencies had no role in the design of the study, data collection, analyses, or interpretation, writing of the manuscript, or in the decision to publish the results. Deutsche Forschungsgemeinschaft — http://dx.doi.org/10.13039/501100001659; ME3696/3–1 – Project-ID 413617135
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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


Publication History

Received: 09 August 2023
Received: 07 March 2024

Accepted: 11 March 2024

Article published online:
02 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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