Temperament profiles, 5-HT2A genotype, and response to treatment with SSRIs in major depression

The Role of Genetics in the Development and Pharmacotherapy of Depression and Its Impact on Drug Discovery

Complex disorders, such as depression, remain a mystery for scientists. Although genetic factors are considered important for the prediction of one's vulnerability, it is hard to estimate the exact risk for a patient to develop depression, based only on one category of vulnerability criteria. Genetic factors also regulate drug metabolism, and when they are identified in a specific combination, may result in increased drug resistance. A proper understanding of the genetic basis of depression assists in the development of novel promising medications and effective disorder management schemes. This review aims to analyze the recent literature focusing on the correlation between specific genes and the occurrence of depression. Moreover, certain aspects targeting a high drug resistance identified among patients suffering from major depressive disorder were highlighted in this manuscript. An expected direction of future drug discovery campaigns was also discussed.

5-HTR1A and 5-HTR2A genetic polymorphisms and SSRI antidepressant response in depressive Chinese patients

OBJECTIVE

Genetic variabilities within the serotoninergic system may predict response or remission to antidepressant drugs. Several serotonin receptor (5-HTR) gene polymorphisms have been associated with susceptibility to psychiatric diseases. In this study, we analyzed the correlation between 5-HTR1A and 5-HTR2A polymorphisms and response or remission to selective serotonin reuptake inhibitors (SSRIs) drugs.

METHODS

Two hundred and ninety patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depressive disorder were involved in this study. SSRIs (fluoxetine, paroxetine, citalopram, or sertraline) were selected randomly for treatment. The Hamilton Rating Scale for Depression was used to evaluate the antidepressant effect. To assess 5-HTR gene variabilities, two single-nucleotide polymorphisms in 5-HTR1A (rs1364043 and rs10042486) and three in 5-HTR2A (rs6311, rs6313, and rs17289304) were genotyped by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry using the Sequenom MassARRAY Analyzer 4 system.

RESULTS

There were 220 responders and 70 nonresponders (120 remissioners and 170 nonremissioners) after 6 weeks of treatment. We found no association between any of the five 5-HTR1A and 5-HTR2A gene polymorphisms and antidepressant drug response or remission (P>0.05). It is worth mentioning that TT genotype frequency of rs10042486 was significantly different from the CT genotype frequency between responders and nonresponders, although the significance was not maintained after correcting for multiple testing.

CONCLUSION

Thus, 5-HTR1A and 5-HTR2A gene polymorphisms may not play an important role in antidepressant drug response or remission.

Association between serotonin cumulative genetic score and the Behavioral Approach System (BAS): Moderation by early life environment

The present study investigates if genetic variation in the serotonergic system interacts with early adversity to predict changes in the Behavioral Approach System (BAS), a system that taps into reward processing. In a sample of community adults (N= 236) the influence of single serotonergic candidate polymorphisms on BAS was analyzed, we also examined the aggregate contribution of these genetic variants by creating a Cumulative Genetic Score (CGS). A CGS quantifies an individual's cumulative risk by aggregating the number of risk alleles across the candidate polymorphisms. After individual gene analysis, three candidate genes rs7305115 (TPH2), rs6311 (HTR2A), and rs6295 (HTR1A) were combined into the CGS. There were no significant interactions between individual candidate polymorphisms and childhood adversity, but the CGS interacted with childhood adversity to explain a significant amount of variance (11.6%) in the BAS. Findings suggest that genetic variations in the serotonergic system in combination with childhood adversity contribute to individual differences in reward sensitivity.

HTR2A gene-child abuse interaction and association with a history of suicide attempt among Caucasian depressed psychiatric inpatients

BACKGROUND

The serotonin transporter gene polymorphism (5HTTLPR) has been associated with vulnerability for depression after exposure to stressful life event as well as with difference in treatment response to SSRI. Although the A/A genotype of the serotonin receptor SNP (rs7997012) was associated with better citalopram response than the G/G in the STAR⁎D sample, the effects of this SNP in the moderation of child abuse history on the characteristics of mental illnesses are not well understood. We examined if there are similar gene-environment interaction with the SNP.

METHODS

Retrospective chart review of 250 Caucasian depressed psychiatric inpatients, who had genotype for rs7997012. Subjects with each genotype were subcategorized into 2 groups with/without history of child abuse. The history of suicide attempts of each group was compared.

RESULTS

A trend for an interaction was found between the HTR2A genotype and child abuse history influencing the prevalence of suicide attempts. Although each genotype did not show significant difference in the risk of suicide attempt when there was no abuse history, the A carriers (A/A+A/G) showed significantly higher rate of suicide attempt compared to the G/G when there is a history of child abuse (48.4% versus 22.7% respectively, p=0.0050). The likelihood ratio test from the logistic model showed a trend for an interaction between the A/A genotype and abuse history (Odds Ratio 2.10, χ(2)=2.49, p=0.11).

LIMITATIONS

Retrospective study design and small sample size with borderline significance.

CONCLUSIONS

Our findings showed a potential interaction between the HTR2A gene and stressful life events.

Behavioral deficits and exaggerated feedback control over raphe-hippocampal serotonin neurotransmission in restrained rats

Serotonin (5-hydroxytryptamine, 5-HT), acting via the hippocampus, is thought to be critical for the neuroadaptation that alleviates the adverse effects of stress on emotion and behavior. It was hypothesized that a decrease in raphe-hippocampal serotonin neurotransmission caused by exaggerated feedback inhibition of 5-HT synthesis and release significantly contributes to stress-induced behavioral deficits. Acute exposure to 2 h of restraint stress increased 5-HT metabolism in the cortex and raphe region but had no such effect in the hippocampus. Exposure to 2 h of restraint stress elicited anxiety-like behavior, which was monitored in the light-dark transition test the next day. Animals sacrificed 24 h after termination of the stress period exhibited a decrease in the concentration of 5-HT and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the hippocampus but not in the cortex and raphe. 8-Hydroxy-2-di-n-propylaminotetralin (8-OH-DPAT) injected at doses of 0.125, 0.25 and 0.5 mg/kg decreased 5-HT metabolism in the raphe, cortex and hippocampus of restrained and unrestrained animals, and the decreases in the raphe and hippocampus, but not those in the cortex, were greater in restrained than unrestrained animals. Exaggerated feedback control over raphe-hippocampal serotonin neurotransmission may be involved in the inability of the organism to cope with increased stress and elicits behavioral depression.