Cytochrome P450 testing in the treatment of depression
This chapter reviews studies on the use of CYP450 genotyping as a guide to the management of serotonin reuptake inhibitors (SSRIs) for patients with depression. Comparison of the results of available tests for CYP450 genotype with a reference standard suggests that the analytic sensitivity and specificity of available tests are generally high, although some serious concerns remain. In the evaluation of gene deletions and duplications, assessing the magnitude of the potential error in these analytic parameters is limited by the lack of an established gold standard for gene copy number. Another concern is that few CYP450 variants were interrogated by the studies identified, which focused particularly on the more common variants in Caucasians. In depressed patients who have reached a steady-state concentration of an SSRI, the limited existing data do not demonstrate a clear correlation between CYP450 metabolizer status and (i) SSRI concentrations (an intermediate outcome), (ii) efficacy of SSRIs, or (iii) tolerability of SSRIs.
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