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Bonacina G, Carollo A, Esposito G. The Genetic Side of the Mood: A Scientometric Review of the Genetic Basis of Mood Disorders. Genes (Basel) 2023; 14:genes14020352. [PMID: 36833279 PMCID: PMC9956267 DOI: 10.3390/genes14020352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Mood disorders are highly heritable psychiatric disorders. Over the years, many genetic polymorphisms have been identified to pose a higher risk for the development of mood disorders. To overview the literature on the genetics of mood disorders, a scientometric analysis was performed on a sample of 5342 documents downloaded from Scopus. The most active countries and the most impactful documents in the field were identified. Furthermore, a total of 13 main thematic clusters emerged in the literature. From the qualitative inspection of clusters, it emerged that the research interest moved from a monogenic to a polygenic risk framework. Researchers have moved from the study of single genes in the early 1990s to conducting genome-wide association studies around 2015. In this way, genetic overlaps between mood disorders and other psychiatric conditions emerged too. Furthermore, around the 2010s, the interaction between genes and environmental factors emerged as pivotal in understanding the risk for mood disorders. The inspection of thematic clusters provides a valuable insight into the past and recent trends of research in the genetics of mood disorders and sheds light onto future lines of research.
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Pagani R, Gasparini A, Ielmini M, Caselli I, Poloni N, Ferrari M, Marino F, Callegari C. Twenty years of Lithium pharmacogenetics: A systematic review. Psychiatry Res 2019; 278:42-50. [PMID: 31146140 DOI: 10.1016/j.psychres.2019.05.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 01/31/2023]
Abstract
Lithium is among the best proven treatments for patients diagnosed with Bipolar Disorder, however response to Lithium appears to be considerably variable among individuals and it has been suggested that this inconstancy in Lithium response could be genetically determined. Starting from this perspective, in the last few decades, a number of pharmacogenetic studies have attempted to identify genetic variants, which might be associated with response to Lithium in bipolar patients, in order to develop a pharmacogenetics test to tailor treatment on patients, identifying who will benefit the most from therapy with Lithium. Within this context, authors have critically reviewed pharmacogenetic studies of Lithium response in bipolar disorder, suggesting strategies for future work in this field. Computerized searches of PubMed and Embase databases, for studies published between 1998 and January 2018, was performed: 1162 studies were identified but only 37 relevant papers were selected for detailed review. Despite some interesting preliminary findings, the pharmacogenetics of Lithium and the development of a specific pharmacogenetics test in bipolar disorder appears to be a field still in its infancy, even though the advent of genome-wide association studies holds particular promise for future studies, which should include larger samples.
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Affiliation(s)
- R Pagani
- Clinica Santa Croce, Orselina, Switzerland
| | - A Gasparini
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Viale Borri 57, 2100 Varese, Italy
| | - M Ielmini
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Viale Borri 57, 2100 Varese, Italy
| | - I Caselli
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Viale Borri 57, 2100 Varese, Italy
| | - N Poloni
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Viale Borri 57, 2100 Varese, Italy
| | - M Ferrari
- Department of Clinical Medicine, Division of Experimental and Clinical Pharmacology, University of Insubria, Varese, Italy
| | - F Marino
- Department of Clinical Medicine, Division of Experimental and Clinical Pharmacology, University of Insubria, Varese, Italy
| | - C Callegari
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Viale Borri 57, 2100 Varese, Italy.
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3
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Pisanu C, Heilbronner U, Squassina A. The Role of Pharmacogenomics in Bipolar Disorder: Moving Towards Precision Medicine. Mol Diagn Ther 2018; 22:409-420. [PMID: 29790107 DOI: 10.1007/s40291-018-0335-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bipolar disorder (BD) is a common and disabling psychiatric condition with a severe socioeconomic impact. BD is treated with mood stabilizers, among which lithium represents the first-line treatment. Lithium alone or in combination is effective in 60% of chronically treated patients, but response remains heterogenous and a large number of patients require a change in therapy after several weeks or months. Many studies have so far tried to identify molecular and genetic markers that could help us to predict response to mood stabilizers or the risk for adverse drug reactions. Pharmacogenetic studies in BD have been for the most part focused on lithium, but the complexity and variability of the response phenotype, together with the unclear mechanism of action of lithium, limited the power of these studies to identify robust biomarkers. Recent pharmacogenomic studies on lithium response have provided promising findings, suggesting that the integration of genome-wide investigations with deep phenotyping, in silico analyses and machine learning could lead us closer to personalized treatments for BD. Nevertheless, to date none of the genes suggested by pharmacogenetic studies on mood stabilizers have been included in any of the genetic tests approved by the Food and Drug Administration (FDA) for drug efficacy. On the other hand, genetic information has been included in drug labels to test for the safety of carbamazepine and valproate. In this review, we will outline available studies investigating the pharmacogenetics and pharmacogenomics of lithium and other mood stabilizers, with a specific focus on the limitations of these studies and potential strategies to overcome them. We will also discuss FDA-approved pharmacogenetic tests for treatments commonly used in the management of BD.
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Affiliation(s)
- Claudia Pisanu
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, sp 6, 09042, Cagliari, Italy
- Department of Neuroscience, Unit of Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Alessio Squassina
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, sp 6, 09042, Cagliari, Italy.
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
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Budde M, Degner D, Brockmöller J, Schulze TG. Pharmacogenomic aspects of bipolar disorder: An update. Eur Neuropsychopharmacol 2017; 27:599-609. [PMID: 28342679 DOI: 10.1016/j.euroneuro.2017.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/31/2017] [Accepted: 02/09/2017] [Indexed: 12/11/2022]
Abstract
The hopes for readily implementable precision medicine are high. For many complex disorders, such as bipolar disorder, these hopes critically hinge on tangible successes in pharmacogenetics of treatment response or susceptibility to adverse events. In this article, we review the current state of pharmacogenomics of bipolar disorder including latest results from candidate genes and genome-wide association studies. The majority of studies focus on response to lithium treatment. Although a host of genes has been studied, hardly any replicated findings have emerged so far. Very small samples sizes and heterogeneous phenotype definition may be considered the major impediments to success in this field. Drawing from current experiences and successes in studies on diagnostic psychiatric phenotypes, we suggest several approaches for our way forward.
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Affiliation(s)
- M Budde
- Institute of Psychiatric Phenomics and Genomics, Clinical Center of the University of Munich, Nussbaumstr. 7, 80336 Munich, Germany; University Medical Center Göttingen, Department of Psychiatry and Psychotherapy, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - D Degner
- University Medical Center Göttingen, Department of Psychiatry and Psychotherapy, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - J Brockmöller
- University Medical Center Göttingen, Department of Clinical Pharmacology, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - T G Schulze
- Institute of Psychiatric Phenomics and Genomics, Clinical Center of the University of Munich, Nussbaumstr. 7, 80336 Munich, Germany; University Medical Center Göttingen, Department of Psychiatry and Psychotherapy, Von-Siebold-Str. 5, 37075 Göttingen, Germany
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5
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Fatemi SH, Folsom TD, Thuras PD. GABA A and GABA B receptor dysregulation in superior frontal cortex of subjects with schizophrenia and bipolar disorder. Synapse 2017; 71. [PMID: 28316115 DOI: 10.1002/syn.21973] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/21/2017] [Accepted: 03/14/2017] [Indexed: 11/12/2022]
Abstract
Schizophrenia and bipolar disorder are complex psychiatric disorders that affect millions of people worldwide. Evidence from gene association and postmortem studies has identified abnormalities of the gamma-aminobutyric acid (GABA) signaling system in both disorders. Abnormal GABAergic signaling and transmission could contribute to the symptomatology of these disorders, potentially through impaired gamma oscillations which normally occur during cognitive processing. In the current study, we examined the protein expression of 14 GABAA and two GABAB receptor subunits in the superior frontal cortex of subjects with schizophrenia, bipolar disorder, and healthy controls. Analyses of Variance (ANOVAs) identified significant group effects for protein levels for the α1, α6, β1, β3, δ, ɛ, and π GABAA receptor subunits and R1 and R2 GABAB receptor subunits. Follow-up t tests confirmed changes for these subunits in subjects with schizophrenia, subjects with bipolar disorder, or both groups. Alterations in stoichiometry of GABA receptor subunits could result in altered ligand binding, transmission, and pharmacology of GABA receptors in superior frontal cortex. Thus, impaired GABAergic transmission may negatively contribute to symptoms such as anxiety or panic as well as impaired learning and information processing, all of which are disrupted in schizophrenia and bipolar disorder. Taken together, these results provide additional evidence of GABAergic receptor abnormalities in these disorders.
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Affiliation(s)
- S Hossein Fatemi
- Department of Psychiatry, Division of Neuroscience Research, University of Minnesota Medical School, 420 Delaware St. SE, MMC 392, Minneapolis, Minnesota, 55455.,Department of Neuroscience, University of Minnesota Medical School, 321 Church St. SE, Minneapolis, Minnesota, 55455
| | - Timothy D Folsom
- Department of Psychiatry, Division of Neuroscience Research, University of Minnesota Medical School, 420 Delaware St. SE, MMC 392, Minneapolis, Minnesota, 55455
| | - Paul D Thuras
- Department of Psychiatry, VA Medical Center, 1 Veterans Drive Minneapolis, Minnesota, 55417-2399
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Santoro ML, Moretti PN, Pellegrino R, Gadelha A, Abílio VC, Hayashi MAF, Belangero SI, Hakonarson H. A current snapshot of common genomic variants contribution in psychiatric disorders. Am J Med Genet B Neuropsychiatr Genet 2016; 171:997-1005. [PMID: 27486013 DOI: 10.1002/ajmg.b.32475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/06/2016] [Indexed: 12/22/2022]
Abstract
In the past decade, numerous advances were achieved in psychiatric genetics. Particularly, the genome wide association studies (GWAS) have contributed to uncovering new genes and pathways associated to psychiatric disorders (PDs). At the same time, with increasing sample sizes in the GWAS, the polygenic risk score (PRS) promoted an additional tool for identification and evaluation the genetic risk quantitatively in PDs. This concept review presents the state of the art GWAS analysis and PRS focusing on the genetic underpinnings of PDs. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marcos L Santoro
- Interdisciplinary Laboratory of Clinical Neurosciences, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Genetics Division, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Patricia N Moretti
- Interdisciplinary Laboratory of Clinical Neurosciences, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Genetics Division, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Renata Pellegrino
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ary Gadelha
- Interdisciplinary Laboratory of Clinical Neurosciences, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Vanessa C Abílio
- Interdisciplinary Laboratory of Clinical Neurosciences, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Department of Pharmacology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Mirian A F Hayashi
- Interdisciplinary Laboratory of Clinical Neurosciences, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Department of Pharmacology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Sintia I Belangero
- Interdisciplinary Laboratory of Clinical Neurosciences, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Genetics Division, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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7
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Can A, Schulze TG, Gould TD. Molecular actions and clinical pharmacogenetics of lithium therapy. Pharmacol Biochem Behav 2014; 123:3-16. [PMID: 24534415 DOI: 10.1016/j.pbb.2014.02.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 02/04/2014] [Accepted: 02/05/2014] [Indexed: 12/21/2022]
Abstract
Mood disorders, including bipolar disorder and depression, are relatively common human diseases for which pharmacological treatment options are often not optimal. Among existing pharmacological agents and mood stabilizers used for the treatment of mood disorders, lithium has a unique clinical profile. Lithium has efficacy in the treatment of bipolar disorder generally, and in particular mania, while also being useful in the adjunct treatment of refractory depression. In addition to antimanic and adjunct antidepressant efficacy, lithium is also proven effective in the reduction of suicide and suicidal behaviors. However, only a subset of patients manifests beneficial responses to lithium therapy and the underlying genetic factors of response are not exactly known. Here we discuss preclinical research suggesting mechanisms likely to underlie lithium's therapeutic actions including direct targets inositol monophosphatase and glycogen synthase kinase-3 (GSK-3) among others, as well as indirect actions including modulation of neurotrophic and neurotransmitter systems and circadian function. We follow with a discussion of current knowledge related to the pharmacogenetic underpinnings of effective lithium therapy in patients within this context. Progress in elucidation of genetic factors that may be involved in human response to lithium pharmacology has been slow, and there is still limited conclusive evidence for the role of a particular genetic factor. However, the development of new approaches such as genome-wide association studies (GWAS), and increased use of genetic testing and improved identification of mood disorder patients sub-groups will lead to improved elucidation of relevant genetic factors in the future.
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Affiliation(s)
- Adem Can
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Thomas G Schulze
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Todd D Gould
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, United States.
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8
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Severino G, Squassina A, Costa M, Pisanu C, Calza S, Alda M, Del Zompo M, Manchia M. Pharmacogenomics of bipolar disorder. Pharmacogenomics 2014; 14:655-74. [PMID: 23570469 DOI: 10.2217/pgs.13.51] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Bipolar disorder (BD) is a lifelong severe psychiatric condition with high morbidity, disability and excess mortality. The longitudinal clinical trajectory of BD is significantly modified by pharmacological treatment(s), both in acute and in long-term stages. However, a large proportion of BD patients have inadequate response to pharmacological treatments. Pharmacogenomic research may lead to the identification of molecular predictors of treatment response. When integrated with clinical information, pharmacogenomic findings may be used in the future to determine the probability of response/nonresponse to treatment on an individual basis. Here we present a selective review of pharmacogenomic findings in BD. In light of the evidence suggesting a genetic effect of lithium reponse in BD, we focused particularly on the pharmacogenomic literature relevant to this trait. The article contributes a detailed overview of the current status of pharmacogenomics in BD and offers a perspective on the challenges that can hinder its transition to personalized healthcare.
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Affiliation(s)
- Giovanni Severino
- Laboratory of Molecular Genetics, Section of Neuroscience & Clinical Pharmacology, Department of Biomedical Sciences, Sp 8, Sestu-Monserrato, Km 0.700 CA, University of Cagliari, Cagliari, Italy
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Abstract
Mood stabilizers form a cornerstone in the long-term treatment of bipolar disorder. The first representative of their family was lithium, still considered a prototype drug for the prevention of manic and depressive recurrences in bipolar disorder. Along with carbamazepine and valproates, lithium belongs to the first generation of mood stabilizers, which appeared in psychiatric treatment in the 1960s. Atypical antipsychotics with mood-stabilizing properties and lamotrigine, which were introduced in the mid-1990 s, form the second generation of such drugs. The response of patients with bipolar disorder to mood stabilizers has different levels of magnitude. About one-third of lithium-treated patients are excellent responders, showing total prevention of the episodes, and these patients are clinically characterized by an episodic clinical course, complete remission, a bipolar family history, low psychiatric co-morbidity and a hyperthymic temperament. It has been suggested that responders to carbamazepine or lamotrigine may differ clinically from responders to lithium. The main phenotype of the response to mood stabilizers is a degree of prevention against recurrences of manic and depressive episodes during long-term treatment. The most specific scale in this respect is the so-called Alda scale, where retrospective assessment of lithium response is scored on a 0-10 scale. The vast majority of data on genetic influences on the response to mood stabilizers has been gathered in relation to lithium. The studies on the mechanisms of action of lithium and on the neurobiology of bipolar disorder have led to the identification of a number of candidate genes. The genes studied for their association with lithium response have been those connected with neurotransmitters (serotonin, dopamine and glutamate), second messengers (phosphatidyl inositol [PI], cyclic adenosine-monophosphate [cAMP] and protein kinase C [PKC] pathways), substances involved in neuroprotection (brain-derived neurotrophic factor [BDNF] and glycogen synthase kinase 3-β [GSK-3β]) and a number of other miscellaneous genes. There are no published pharmacogenomic studies of mood stabilizers other than lithium, except for one study of the X-box binding protein 1 (XBP1) gene in relation to the efficacy of valproate. In recent years, a number of genome-wide association studies (GWAS) in bipolar disorders have been performed and some of those have also focused on lithium response. They suggest roles for the glutamatergic receptor AMPA (GRIA2) gene and the amiloride-sensitive cation channel 1 neuronal (ACCN1) gene in long-term lithium response. A promise for better elucidating the genetics of lithium response has been created by the formation of the Consortium on Lithium Genetics (ConLiGen) to establish the largest sample, to date, for the GWAS of lithium response in bipolar disorder. The sample currently comprises more than 1,200 patients, characterized by their response to lithium treatment according to the Alda scale. Preliminary results from this international study suggest a possible involvement of the sodium bicarbonate transporter (SLC4A10) gene in lithium response. It is concluded that the pharmacogenetics of response to mood stabilizers has recently become a growing field of research, especially so far as the pharmacogenetics of the response to lithium is concerned. Clearly, the ConLiGen project is a highly significant step in this research. Although the results of pharmacogenetic studies are of significant scientific value, their possible practical implications are yet to be seen.
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McCarthy MJ, Leckband SG, Kelsoe JR. Pharmacogenetics of lithium response in bipolar disorder. Pharmacogenomics 2011; 11:1439-65. [PMID: 21047205 DOI: 10.2217/pgs.10.127] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Bipolar disorder (BD) is a serious mental illness with well-established, but poorly characterized genetic risk. Lithium is among the best proven mood stabilizer therapies for BD, but treatment responses vary considerably. Based upon these and other findings, it has been suggested that lithium-responsive BD may be a genetically distinct phenotype within the mood disorder spectrum. This assertion has practical implications both for the treatment of BD and for understanding the neurobiological basis of the illness: genetic variation within lithium-sensitive signaling pathways may confer preferential treatment response, and the involved genes may underlie BD in some individuals. Presently, the mechanism of lithium is reviewed with an emphasis on gene-expression changes in response to lithium. Within this context, findings from genetic-association studies designed to identify lithium response genes in BD patients are evaluated. Finally, a framework is proposed by which future pharmacogenetic studies can incorporate advances in genetics, molecular biology and bioinformatics in a pathway-based approach to predicting lithium treatment response.
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Affiliation(s)
- Michael J McCarthy
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
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11
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Abstract
Existing psychotropic medications for the treatment of mental illnesses, including antidepressants, mood stabilizers, and antipsychotics, are clinically suboptimal. They are effective in only a subset of patients or produce partial responses, and they are often associated with debilitating side effects that discourage adherence. There is growing enthusiasm in the promise of pharmacogenetics to personalize the use of these treatments to maximize their efficacy and tolerability; however, there is still a long way to go before this promise becomes a reality. This article reviews the progress that has been made in research toward understanding how genetic factors influence psychotropic drug responses and the challenges that lie ahead in translating the research findings into clinical practices that yield tangible benefits for patients with mental illnesses.
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Affiliation(s)
- Peter P Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, Room 857, 624 North Broadway, Baltimore, MD 21205, USA.
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12
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Smith DJ, Evans R, Craddock N. Predicting response to lithium in bipolar disorder: a critical review of pharmacogenetic studies. J Ment Health 2010; 19:142-56. [PMID: 20433322 DOI: 10.3109/09638230903469103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is difficult to reliably identify clinical predictors of lithium response. In recent years a number of pharmacogenetic studies have attempted to identify genetic variants which might be associated with response to lithium in bipolar patients. AIMS To critically review pharmacogenetic studies of lithium response in bipolar disorder and suggest strategies for future work in this field. METHOD Computerized searches of electronic databases for studies published between 1966 and October 2007. Studies were selected for detailed review according to the following criteria: (i) contained original data; (ii) included bipolar patients (including DSM-IV BP-I and BP-II); and (iii) lithium was the prophylactic agent under study. RESULTS One hundred and fifty studies of interest were identified but only 15 relevant papers were selected for detailed review based on the selection criteria. Despite some interesting preliminary findings, there are substantial methodological limitations with almost all of the studies published to date. These issues are critically reviewed. CONCLUSIONS The pharmacogenetics of lithium response in bipolar disorder remains a field in its infancy. There is a need for large-scale, prospective studies of biologically plausible candidate gene genes. The advent of genome-wide association studies holds particular promise for future studies.
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Affiliation(s)
- Daniel J Smith
- Department of Psychological Medicine, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK.
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13
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Squassina A, Manchia M, Del Zompo M. Pharmacogenomics of mood stabilizers in the treatment of bipolar disorder. HUMAN GENOMICS AND PROTEOMICS : HGP 2010; 2010:159761. [PMID: 20981231 PMCID: PMC2958627 DOI: 10.4061/2010/159761] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/24/2010] [Indexed: 11/20/2022]
Abstract
Bipolar disorder (BD) is a chronic and often severe psychiatric illness characterized by manic and depressive episodes. Among the most effective treatments, mood stabilizers represent the keystone in acute mania, depression, and maintenance treatment of BD. However, treatment response is a highly heterogeneous trait, thus emphasizing the need for a structured informational framework of phenotypic and genetic predictors. In this paper, we present the current state of pharmacogenomic research on long-term treatment in BD, specifically focusing on mood stabilizers. While the results provided so far support the key role of genetic factors in modulating the response phenotype, strong evidence for genetic predictors is still lacking. In order to facilitate implementation of pharmacogenomics into clinical settings (i.e., the creation of personalized therapy), further research efforts are needed.
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Affiliation(s)
- Alessio Squassina
- Laboratory of Molecular Genetics, Unit of Clinical Pharmacology, Department of Neuroscience "B.B. Brodie", University of Cagliari, sp8 Sestu-Monserrato, km. 0,700, Monserrato 09042, Cagliari, Italy
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14
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Abstract
Existing psychotropic medications for the treatment of mental illnesses, including antidepressants, mood stabilizers, and antipsychotics, are clinically suboptimal. They are effective in only a subset of patients or produce partial responses, and they are often associated with debilitating side effects that discourage adherence. There is growing enthusiasm in the promise of pharmacogenetics to personalize the use of these treatments to maximize their efficacy and tolerability; however, there is still a long way to go before this promise becomes a reality. This article reviews the progress that has been made in research toward understanding how genetic factors influence psychotropic drug responses and the challenges that lie ahead in translating the research findings into clinical practices that yield tangible benefits for patients with mental illnesses.
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Affiliation(s)
- Peter P Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, Baltimore, MD 21205, USA.
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15
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Lohoff FW, Ferraro TN. Pharmacogenetic considerations in the treatment of psychiatric disorders. Expert Opin Pharmacother 2010; 11:423-39. [DOI: 10.1517/14656560903508762] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
OBJECTIVE Despite effective pharmacological treatments for bipolar disorder, we still lack a comprehensive pathophysiological model of the illness. Recent neurobiological research has implicated a number of key brain regions and neuronal components in the behavioural and cognitive manifestations of bipolar disorder. Dopamine has previously been investigated in some depth in bipolar disorder, but of late has not been a primary focus of attention. This article examines the role of dopamine in bipolar disorder, incorporating recent advances into established models where possible. METHODS A critical evaluation of the literature was undertaken, including a review of behavioural, neurochemical, receptor, and imaging studies, as well as genetic studies focusing on dopamine receptors and related metabolic pathways. In addition, pharmacologic manipulation of the central dopaminergic pathways and comparisons with other disease states such as schizophrenia were considered, principally as a means of exploring the hypothesised models. RESULTS Multiple lines of evidence, including data from pharmacological interventions and structural and functional magnetic resonance imaging studies, suggest that the dopaminergic system may play a central role in bipolar disorder. CONCLUSION Future research into the pathophysiological mechanisms of bipolar disorder and the development of new treatments for bipolar disorder should focus on the dopaminergic system.
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Affiliation(s)
- David A Cousins
- Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
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17
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Manchia M, Congiu D, Squassina A, Lampus S, Ardau R, Chillotti C, Severino G, Del Zompo M. No association between lithium full responders and the DRD1, DRD2, DRD3, DAT1, 5-HTTLPR and HTR2A genes in a Sardinian sample. Psychiatry Res 2009; 169:164-6. [PMID: 19647327 DOI: 10.1016/j.psychres.2008.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 11/18/2008] [Accepted: 12/17/2008] [Indexed: 11/17/2022]
Abstract
Polymorphisms within the DRD1, DRD2, DRD3, DAT1, 5-HTTLPR and HTR2A genes are being studied for association with lithium prophylaxis in a sample of 155 Sardinian unrelated probands affected by bipolar disorder (BP). No significant association was shown between the polymorphisms of the genes studied and response to lithium treatment.
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Affiliation(s)
- Mirko Manchia
- Section of Clinical Pharmacology, Department of Neurosciences "B.B. Brodie", University of Cagliari, P.O. San Giovanni di Dio, Via Ospedale 46, 09124 Cagliari, Italy.
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18
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Common genetic, clinical, demographic and psychosocial predictors of response to pharmacotherapy in mood and anxiety disorders. Int Clin Psychopharmacol 2009; 24:1-18. [PMID: 19060722 DOI: 10.1097/yic.0b013e32831db2d7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study is to summarize available knowledge about common genetic, clinical, demographic and psychosocial predictors of response to pharmacotherapy in mood and anxiety disorders. A literature search was carried out by using MEDLINE and references of selected articles. The search included articles published up to March 2008. The main genetic finding concerns the serotonin transporter gene promoter polymorphisms, the long variant of which seems to be related to a positive response to therapy in mood disorders and could also have a role in the treatment of anxiety disorders. Among other predictors, the main factors common to both classes of disorder are comorbid axis II disorders and early onset of illness, which are related to a worse response to therapy and concomitant good physical conditions, absence of earlier treatments, early administration and response to therapies, and higher self- directedness, which is related to a better outcome. Many common predictors have been identified and these seem to be related to features covering the totality of patients that go beyond specific characteristics of single disorders. Possible limitations and suggestions for future research based on a more integrated vision of human complexity are discussed.
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19
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Michelon L, Meira-Lima I, Cordeiro Q, Miguita K, Breen G, Collier D, Vallada H. Association study of the INPP1, 5HTT, BDNF, AP-2beta and GSK-3beta GENE variants and restrospectively scored response to lithium prophylaxis in bipolar disorder. Neurosci Lett 2006; 403:288-93. [PMID: 16787706 DOI: 10.1016/j.neulet.2006.05.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 04/28/2006] [Accepted: 05/01/2006] [Indexed: 11/22/2022]
Abstract
In the present study we investigated the influence of a series variants in genes (the serotonin transporter, glycogen synthase kinase-3beta, inositol polyphosphatase 1-phosphate, brain-derived neurotrophic factor and activator protein 2beta) related to the action of lithium carbonate, a drug used for prophylaxis in mood disorders. We used a sample of unrelated patients with bipolar disorder type I on lithium therapy for at least 2 years who met the proposed response criteria for prophylactic response. Of the 134 patients, 61 patients were considered full responders, 49 non-responders and 24 partial responders. No significant differences were observed for the genotype or allele frequencies for good, partial and poor responders for the five gene variants: for BDNF G196A (genotype: chi2 = 3.67, 4 d.f., p = 0.45; allele: chi2 = 2.31, 2 d.f., p = 0.31); for INPP1 C973A (genotype: chi2 = 1.35, 4 d.f., p = 0.85; allele: chi2 = 0.04, 2 d.f., p = 0.98); for AP-2beta [CAAA](4/5) (genotype: chi2 = 3.18; 4 d.f., p = 0.52; allele: chi2 = 0.92, 2 d.f., p = 0.063); for 5HTTLPR (genotype: chi2 = 0.67, 4 d.f., p = 0.96; allele: chi2 = 0.27, 2 d.f., p = 0.87); for GSK-3beta A-1727T (genotype: chi2 = 3.55, 4 d.f., p = 0.47; allele: chi2 = 0.48, 2 d.f., p = 0.78). These investigated variants are not predictive factors for lithium prophylactic response in our sample of bipolar disorder type I patients. However, it is still possible that a subgroup of a diverse ethnic ancestry may be predisposing to some of those variants for lithium response.
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Affiliation(s)
- Leandro Michelon
- Department and Institute of Psychiatry (ProGene LIM-23), University of São Paulo Medical School, Brazil
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20
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Mann JJ, Currier D. Effects of genes and stress on the neurobiology of depression. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2006; 73:153-89. [PMID: 16737904 DOI: 10.1016/s0074-7742(06)73005-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- J John Mann
- Department of Psychiatry, Division of Neuroscience, Columbia University, New York, New York 10032, USA
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21
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Serretti A, Artioli P, Quartesan R. Pharmacogenetics in the treatment of depression: pharmacodynamic studies. Pharmacogenet Genomics 2005; 15:61-7. [PMID: 15861029 DOI: 10.1097/01213011-200502000-00001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The pharmacological treatment of mood disorders has reduced their morbidity and improved mental health for millions of individuals worldwide, favouring a considerable reduction of the direct and indirect costs caused by these common pathologies. Unfortunately, not all individuals benefit, and 30-40% of patients do not show a complete response to treatment. Efficient clinical predictors are not available, although genetic factors are thought to play a substantial (but complex) role in the antidepressant response. Pharmacogenetics, which investigates the influence of genetic features on the pharmacological response, has gained increasing attention and holds great promise for clinical psychiatry. Here, a brief overview is provided on the various pharmacogenetic studies published to date that analyse the commonest treatments for depression: antidepressants, sleep deprivation and lithium salts.
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Affiliation(s)
- Alessandro Serretti
- Department of Psychiatry, Vita-Salute University, San Raffaele Hospital, Milan Italy.
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22
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Ruzickova M, Turecki G, Alda M. Pharmacogenetics and mood stabilization in bipolar disorder. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2004; 123C:18-25. [PMID: 14601033 DOI: 10.1002/ajmg.c.20010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bipolar disorder is a severe psychiatric disease characterized by varying treatment response among individual patients. Effects of certain treatments, for instance, lithium, can be predicted from clinical characteristics of patients and their family histories. This led to a suggestion that a treatment response could identify subtypes of bipolar disorder particularly suited for gene-mapping studies. In this paper we review family and molecular studies of bipolar disorder responsive to lithium, as well as studies aiming to identify polymorphisms associated with the treatment response itself. While molecular genetic research and gene expression studies promise to bring new insights into the pathophysiology of the illness and the nature of treatment response, and thus provide new information for better treatment of bipolar disorder in the future, results from family studies and studies of clinical correlates of treatment response may already be utilized in the management of bipolar disorder.
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Mamdani F, Groisman IJ, Alda M, Turecki G. Pharmacogenetics and bipolar disorder. THE PHARMACOGENOMICS JOURNAL 2004; 4:161-70. [PMID: 15079146 DOI: 10.1038/sj.tpj.6500245] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bipolar disorder (BD) is a major psychiatric condition that commonly requires prophylactic and episodic treatment. There is important variability in the therapeutic response and side-effect profiles to currently available pharmacological agents. Pharmacogenetics have provided new hopes to develop more efficient treatment strategies tailored to the individual patient's needs. This review assesses nonsystematically studies using pharmacogenetic strategies in BD. Most of these studies have focused on patients selected according to lithium response, and more recently, a growing number of studies have been investigating genetic factors in mixed samples of patients classified according to response to antidepressant treatment. Although previous clinical and family studies support the use of pharmacogenetic strategies both to increase phenotype homogeneity as well as to identify genetic factors that may mediate response to treatment, most molecular studies carried out to date are still preliminary and in need of external validation. A major problem has been comparability between studies, in part, because of differences in the criteria used to define response. More attention should be paid to standardize the criteria for drug response definition.
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Affiliation(s)
- F Mamdani
- Douglas Hospital Research Centre, McGill University, Montreal, Quebec, Canada
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24
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Abstract
This article presents a conceptual review of the genetic underpinnings of psychotic mood disorders. Both unipolar and bipolar forms of mood disorder sometimes feature psychotic symptoms. Some evidence from epidemiological research suggests that psychotic forms of mood disorder specifically might be heritable. Linkage studies of mood disorders in general have also provided some support for that notion, as have associated studies involving serotonin and dopamine genes and psychotic mood disorder. Some research suggests there might be a genetic connection between schizophrenia and bipolar disorder, undermining the Kraepelinian dichotomous classification of the psychoses. Future research should continue to examine psychotic forms of mood disorder using both epidemiological and molecular approaches.
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Affiliation(s)
- Ming T Tsuang
- Harvard Medical School Department of Psychiatry at the Massachusetts Mental Health Center, 74 Fenwood Road, Boston, MA, USA.
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25
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Horiuchi Y, Nakayama J, Ishiguro H, Ohtsuki T, Detera-Wadleigh SD, Toyota T, Yamada K, Nankai M, Shibuya H, Yoshikawa T, Arinami T. Possible association between a haplotype of the GABA-A receptor alpha 1 subunit gene (GABRA1) and mood disorders. Biol Psychiatry 2004; 55:40-5. [PMID: 14706423 DOI: 10.1016/s0006-3223(03)00689-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The gamma-aminobutyric acid (GABA) neurotransmitter system has been implicated in the pathogenesis of mood disorders. The GABRA1 gene encodes one of the subunits of GABA-A receptor and is located on human chromosome 5q34-q35, which is a region reportedly linked to mood disorders. We examined the GABRA1 gene as a candidate for mood disorders. METHODS We performed mutation screening of GABRA1 in 24 Japanese bipolar patients and evaluated associations in Japanese case-control subjects consisting of 125 patients with bipolar disorder, 147 patients with depressive disorders, and 191 healthy control subjects. Associations were confirmed in the National Institute of Mental Health (NIMH) Initiative Bipolar Pedigrees, which consists of 88 multiplex pedigrees with 480 informative persons. RESULTS We identified 13 polymorphisms in the GABRA1 gene. Nonsynonymous mutations were not found. Association of a specific haplotype with affective disorders was suggested in the Japanese case-control population (corrected p=.0008). This haplotype association was confirmed in the NIMH pedigrees (p=.007). CONCLUSIONS These results indicate that the GABRA1 gene may play a role in the etiology of bipolar disorders.
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Affiliation(s)
- Yasue Horiuchi
- Department of Medical Genetics, Institute of Basic Medical Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Mamdani F, Jaitovich Groisman I, Alda M, Turecki G. Long-term responsiveness to lithium as a pharmacogenetic outcome variable: treatment and etiologic implications. Curr Psychiatry Rep 2003; 5:484-92. [PMID: 14609504 DOI: 10.1007/s11920-003-0088-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The importance of genes in the etiology of bipolar disorder has been substantiated through family, twin, and adoption studies. Bipolar disorder is treated at the prophylactic and episodic levels; lithium is one of the most common forms of prophylactic treatment. Recently, pharmacogenetics has come to play an active role in the elucidation of genetic factors that may play a role in modulating lithium response. This strategy has provided hope for advancements in understanding the genetics of lithium-responsive bipolar disorder. This review encompasses studies that have used populations of lithium responders and non-responders to carry out family, linkage, or association studies, as well as some insight into possible mechanisms by which lithium produces its prophylactic effect. Although data examining the pharmacogenetics of bipolar disorder remain scarce, this is a promising avenue of investigation to help genetically define more homogeneous populations or to search for genetic predictors of drug response.
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Affiliation(s)
- Firoza Mamdani
- Douglas Hospital Research Centre, 6875 LaSalle Boulevard, Verdun, Quebec H4H 1R3, Canada
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27
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Serretti A, Artioli P. Predicting response to lithium in mood disorders: role of genetic polymorphisms. AMERICAN JOURNAL OF PHARMACOGENOMICS : GENOMICS-RELATED RESEARCH IN DRUG DEVELOPMENT AND CLINICAL PRACTICE 2003; 3:17-30. [PMID: 12562213 DOI: 10.2165/00129785-200303010-00004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Lithium is considered to be the first choice mood stabilizer in recurrent mood disorders. Its widespread and large-scale use is the result of its proven efficacy. In spite of this fact, patients have been observed to show a variable response to lithium treatment: in some cases it is completely effective in preventing manic or depressive relapses, while in other cases it appears to show no influence on the disease course. The possible definition of a genetic liability profile for adverse effects and efficacy will be of great help, as lithium therapy needs at least 6 months to be effective in stabilizing mood disorders. During the last few years, a number of groups have reported possible liability genes. Lithium long-term prophylactic efficacy has been associated with serotonin transporter protein, tryptophan hydroxylase and inositol polyphosphate 1-phosphatase variants. A number of other candidate genes and anonymous markers did not yield positive associations. Therefore, even if some positive results have been reported, no unequivocal susceptibility gene for lithium efficacy has been identified. Although the available data may not currently allow a meaningful prediction of lithium response, future research is aimed at the development of individualized treament of mood disorders, including the possibility of 'pharmacological genetic counseling'.
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Affiliation(s)
- Alessandro Serretti
- Department of Psychiatry, Vita-Salute University, San Raffaele Institute, Milan, Italy.
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28
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Abstract
The authors review the available literature on the preclinical and clinical studies involving GABAergic neurotransmission in mood disorders. Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter present almost exclusively in the central nervous system (CNS), distributed across almost all brain regions, and expressed in interneurons modulating local circuits. The role of GABAergic dysfunction in mood disorders was first proposed 20 years ago. Preclinical studies have suggested that GABA levels may be decreased in animal models of depression, and clinical studies reported low plasma and CSF GABA levels in mood disorder patients. Also, antidepressants, mood stabilizers, electroconvulsive therapy, and GABA agonists have been shown to reverse the depression-like behavior in animal models and to be effective in unipolar and bipolar patients by increasing brain GABAergic activity. The hypothesis of reduced GABAergic activity in mood disorders may complement the monoaminergic and serotonergic theories, proposing that the balance between multiple neurotransmitter systems may be altered in these disorders. However, low GABAergic cortical function may probably be a feature of a subset of mood disorder patients, representing a genetic susceptibility. In this paper, we discuss the status of GABAergic hypothesis of mood disorders and suggest possible directions for future preclinical and clinical research in this area.
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Affiliation(s)
- P Brambilla
- Biological Psychiatry Unit, IRCCS S Giovanni di Dio, Fatebenefratelli, Brescia, Italy.
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29
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Abstract
In order to prescribe lithium appropriately to patients with bipolar disorder, predictors of lithium response are helpful. The present paper reviews the biological predictors of lithium response. As a positive predictor of lithium response, the following have been reported: strong loudness dependence of the auditory-evoked N1/P2-response; higher brain lithium concentration; lower inositol monophosphatase (IMPase) mRNA expression; higher serotonin-induced calcium mobilization; increased N-acetyl-aspartate peak and decreased myo-inositol peak; white matter hyperintensity; decreased intracellular pH; higher frequency of phospholipase C gamma-1 (PLCG1)-5 repeat and PLCG1-8 repeat; and C973A polymorphism in the inositol polyphosphate 1-phosphatase gene. In contrast the following have been reported as a predictor of negative lithium response: epileptiform abnormality of electroencephalography; human leukocyte antigen type A3; decreased phosphocreatine peak area after photic stimulation; and homozygotes for the short variant of the serotonin transporter gene. Most of the possible biological predictors of better lithium response, such as lower IMPase mRNA levels, white matter hyperintensity, lower brain intracellular pH, enhanced calcium response, and PLCG1-5 repeat had been detected as risk factors for bipolar disorder, suggesting that bipolar disorder responding well to maintenance lithium treatment is a distinct category having a certain neurobiological basis, although these findings need further replication. The search for biological predictors of lithium response is still in its infancy. Most of the laboratory or neuroimaging techniques used in these studies are not easily performed in clinical settings, so the development of an easy and useful laboratory test is needed.
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Affiliation(s)
- Akifumi Ikeda
- Kichijoji Hospital, Department of Neuropsychiatry, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
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30
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Abstract
This paper reviews current knowledge of genetic factors in the treatment of bipolar disorder. Most studies to date have investigated genetic differences between responders and non-responders to lithium. The most provocative findings have been obtained in studies of serotonin transporter gene. Another promising application of pharmacogenetic research is the identification of subgroups of bipolar disorder defined by response (or non-response) to pharmacological treatments. Such subgroups could be used to define more homogeneous patient populations for gene-mapping studies.
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Affiliation(s)
- Martin Alda
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, Room 4031, 5909 Jubilee Road, Halifax, Nova Scotia, B3H 2E2, Canada.
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31
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Abstract
The aim of this study was to investigate the seasonal time course of lithium blood levels. We analyzed lithium plasma and red blood cell (RBC) levels in 186 subjects affected by bipolar (n=134) and major depressive (n=52) disorder, with stable oral dosage, followed in our lithium clinic for an average of 36 months. We observed a significant elevation of lithium plasma levels in summer with a more marked variation among early-onset subjects, bipolar subtype, and females. Lithium levels in plasma peaked in summer, and levels in RBC showed a trend in the same direction. Possible stratification factors such as presence of affected relatives or psychotic features did not significantly influence results. In conclusion, we observed a significant variation of lithium plasma levels according to seasons. If confirmed, this finding could have both clinical and research implications.
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Affiliation(s)
- Cristina Cusin
- Department of Psychiatry, Vita-Salute University, Fondazione Centro San Raffaele del Monte Tabor, Via Stamira D'Ancona 20, 20127, Milan, Italy
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Serretti A, Lorenzi C, Lilli R, Mandelli L, Pirovano A, Smeraldi E. Pharmacogenetics of lithium prophylaxis in mood disorders: analysis of COMT, MAO-A, and Gbeta3 variants. AMERICAN JOURNAL OF MEDICAL GENETICS 2002; 114:370-9. [PMID: 11992559 DOI: 10.1002/ajmg.10357] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We studied the possible association between the prophylactic efficacy of lithium in mood disorders and the following gene variants: catechol-O-methyltransferase (COMT) G158A, monoamine oxydase A (MAO-A) 30-bp repeat, G-protein beta 3-subunit (Gbeta3) C825T. A total of 201 subjects affected by bipolar (n = 160) and major depressive (n = 41) disorder were followed prospectively for an average of 59.8 months and were typed for their gene variants using PCR techniques. COMT, MAO-A, and Gbeta3 variants were not associated with lithium outcome, even when possible stratification effects such as sex, polarity, age at onset, duration of lithium treatment, and previous episodes were included in the model. The pathways influenced by those variants are not therefore involved with long-term lithium outcome in our sample.
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Affiliation(s)
- Alessandro Serretti
- Department of Psychiatry, Vita-Salute University, Fondazione Centro San Raffaele del Monte Tabor, Milan, Italy.
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Serretti A, Lilli R, Mandelli L, Lorenzi C, Smeraldi E. Serotonin transporter gene associated with lithium prophylaxis in mood disorders. THE PHARMACOGENOMICS JOURNAL 2002; 1:71-7. [PMID: 11913731 DOI: 10.1038/sj.tpj.6500006] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to investigate the possible association between the functional polymorphism in the upstream regulatory region of the serotonin transporter gene (5-HTTLPR) and the prophylactic efficacy of lithium in mood disorders. Two hundred and one subjects affected by bipolar (n = 167) and major depressive (n = 34) disorder were followed prospectively for an average of 58.2 months and were typed for their 5-HTTLPR variant using polymerase chain reaction techniques. 5-HTTLPR variants were associated with lithium outcome (F = 5.35; df = 2,198; P = 0.005). Subjects with the s/s variant showed a worse response compared to both l/s and l/l variants. Consideration of possible stratification effects such as sex, polarity, age at onset, duration of lithium treatment and previous episodes did not influence the observed association. 5-HTTLPR variants may be a possible influencing factor for the prophylactic efficacy of lithium in mood disorders.
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Affiliation(s)
- A Serretti
- Department of Psychiatry, Vita-Salute University, San Raffaele Institute, Milan, Italy.
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Abstract
To review the pharmacogenetics of bipolar disorders, the authors searched databases for genetic association and linkage studies involving response to long-term prophylactic lithium treatment, as well as treatment with antidepressants or clozapine. Significant ethnic variations in the metabolism and efficacy of antidepressants, as well as clozapine, have been reported by several groups. Systematic studies suggest that that genetic factors affect the response to prophylactic lithium treatment. Numerous associations between the three traits of interest and candidate gene polymorphisms have been proposed. Among these, an association between the serotonin transporter gene and response to serotonin reuptake inhibitors appears robust. Considerable interest has also focused on serotonergic gene polymorphisms and response to clozapine. Response to pharmacotherapy in bipolar disorders may be mediated by genetic factors, but the role played by heritability is unknown.
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Affiliation(s)
- Hader A Mansour
- Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Room 443, Pittsburgh, PA 15213, USA
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35
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Abstract
Pharmacogenetics will be of substantial help in the field of affective disorders pharmacotherapy. The possible definition of a genetic liability profile for drug side-effects and efficacy will be of great help in treatments that need weeks to months to be effective. During the last few years, a number of groups have reported possible liability genes. The efficacy and time of onset of selective serotonin reuptake inhibitors have been associated with a polymorphism in the promoter region of the transporter (SERTPR) in many independent studies, while variants at the tryptophan hydroxylase gene, 5-HT2a receptor and G-protein beta3 have been associated with them in pilot studies. Lithium long-term prophylactic efficacy has been associated with SERTPR, TPH and inositol polyphosphate 1-phosphatase variants, though in unreplicated samples. A number of further candidate genes were not associated with these treatments. In conclusion, both acute and long-term treatments appear to be, at least to some extent, under genetic influence and preliminary data have identified possible liability genes.
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Affiliation(s)
- Alessandro Serretti
- Department of Psychiatry, Instituto Scientifico H San Raffaele, Vita-Salute University, Fondazione Centro San Raffaele del Monte Tabor, Via Stamira D'Ancona 20, 20127, Milan, Italy.
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36
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Massat I, Souery D, Del-Favero J, Van Gestel S, Serretti A, Macciardi F, Smeraldi E, Kaneva R, Adolfsson R, Nylander PO, Blackwood D, Muir W, Papadimitriou GN, Dikeos D, Oru? L, Segman RH, Ivezi? S, Aschauer H, Ackenheil M, Fuchshuber S, Dam H, Jakovljevi? M, Peltonen L, Hilger C, Hentges F, Staner L, Milanova V, Jazin E, Lerer B, Van Broeckhoven C, Mendlewicz J. Positive association of dopamine D2 receptor polymorphism with bipolar affective disorder in a European multicenter association study of affective disorders. ACTA ACUST UNITED AC 2002. [DOI: 10.1002/ajmg.10118] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Serretti A. Lithium long-term treatment in mood disorders: clinical and genetic predictors. Pharmacogenomics 2002; 3:117-29. [PMID: 11966408 DOI: 10.1517/14622416.3.1.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lithium is the most widely used long-term treatment for recurrent mood disorders. Despite its proven efficacy, patients show a variable response, ranging from complete efficacy to no influence at all. This paper reviews possible predictors of response focusing on molecular genetic studies. The functional polymorphism in the upstream regulatory region of the serotonin transporter gene (5-HTTLPR) has been associated with lithium long-term efficacy in two independent studies, marginal associations have been reported for tryptophan hydroxylase and inositol polyphosphate 1-phosphatase (INPP1). A number of other candidate genes and anonymous markers did not yield positive associations. Therefore, even though some positive results have been reported, no unequivocal susceptibility gene for lithium efficacy has been identified.
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Affiliation(s)
- Alessandro Serretti
- Department of Psychiatry, Istituto Scientifico H San Raffaele, Vita-Salute University, San Raffaele Institute, via Stamira D'Ancona 20, 20127 Milan, Italy.
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38
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Abstract
OBJECTIVES This paper reviews the pharmacogenetics of mood disorders. METHODS We have searched the literature for published studies and abstracts relevant for genetic effects in acute antidepressant treatment and in long-term prophylactic treatment. RESULTS The most promising findings to date show an association of the serotonin transporter (5-HTT) gene and the response to serotonin reuptake inhibitors. Genetic factors also appear to play a significant role in the outcome of long-term lithium treatment. The phenotype of lithium-responsive bipolar disorder is associated with stronger genetic effects as well as with an increased phenotypic homogeneity. CONCLUSIONS Genetic factors likely influence treatment response in mood disorders. Clarifying their precise role will have implications for treatment as well as for understanding the pathophysiological mechanisms of these disorders.
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Affiliation(s)
- M Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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39
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Abstract
Lithium is a potent prophylactic medication and mood stabilizer in bipolar disorder. However, clinical outcome is variable, and its therapeutic effect manifests after a period of chronic treatment, implying a progressive and complex biological response process. Signal transduction systems known to be perturbed by lithium involve phosphoinositide (PI) turnover, activation of the Wnt pathway via inhibition of glycogen synthase kinase-3beta (GSK-3beta), and a growth factor-induced, Akt-mediated signalling that promotes cell survival. These pathways, acting in synergy, probably prompt the amplification of lithium signal causing such immense impact on the neuronal network. The sequencing of the human genome presents an unparallelled opportunity to uncover the full molecular repertoire involved in lithium action. Interrogation of high-resolution expression microarrays and protein profiles represents a strategy that should help accomplish this goal. A recent microarray analysis on lithium-treated versus untreated PC12 cells identified multiple differentially altered transcripts. Lithium-perturbed genes, particularly those that map to susceptibility regions, could be candidate risk-conferring factors for mood disorders. Transcript and protein profiling in patients could reveal a lithium fingerprint for responsiveness or nonresponsiveness, and a signature motif that may be diagnostic of a specific phenotype. Similarly, lithium-sensitive gene products could provide a new generation of pharmacological targets.
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Affiliation(s)
- S D Detera-Wadleigh
- National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD 20892-4094, USA.
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40
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Abstract
Many genetic studies have focussed on dopamine receptors and their relationship to neuropsychiatric disease. Schizophrenia, bipolar disorder, and substance abuse have been the most studied, but no conclusive linkage or association has been found. The possible influence of dopamine receptor variants on drug response has not received as much attention. While there is some evidence that polymorphisms and mutations in dopamine receptors can alter functional activity and pharmacological profiles, no conclusive data link these gene variants to drug response or disease. The lack of unequivocal findings may be related, in part, to the subtle changes in receptor pharmacology that these polymorphisms and mutations mediate. These subtle effects may be obscured by the influence of genes controlling drug metabolism and kinetics. Further insight into the pharmacogenetics of dopamine receptors may require not just more studies, but novel approaches to the study of complex genetic traits and diseases.
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MESH Headings
- Animals
- Dopamine Agents/pharmacology
- Humans
- Polymorphism, Genetic/genetics
- Receptors, Dopamine/drug effects
- Receptors, Dopamine/genetics
- Receptors, Dopamine D1/drug effects
- Receptors, Dopamine D1/genetics
- Receptors, Dopamine D2/drug effects
- Receptors, Dopamine D2/genetics
- Receptors, Dopamine D3
- Receptors, Dopamine D4
- Receptors, Dopamine D5
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Affiliation(s)
- A H Wong
- Centre for Addiction and Mental Health, 250 College Street, M5T 1R8, Toronto, ON, Canada.
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41
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Abstract
Clinical predictors of the efficacy of lithium prophylaxis in mood disorders have great potential value. Melancholic features during depressive phases have been both proposed and rejected as valid predictors of favorable outcome. The aim of the present study is to describe the validity of melancholic features during depressive phases as predictors of the prophylactic efficacy of lithium. Sixty-one subjects affected by bipolar (n = 51) and major depressive (n = 10) disorder were followed prospectively for an average of 53 months. All subjects were evaluated as a lifetime perspective at intake, by the Operational Criteria checklist for psychotic illness (OPCRIT). Melancholic features were correlated with outcome only when controlling for time of first lithium administration. These two variables accounted for more than 30% of the total variance in lithium response. Others clinical factors such as polarity, delusions, gender, onset, personality disorders, and family history of mood disorders did not influence the observed association. Our preliminary findings suggest that melancholic features may be associated with favorable lithium prophylactic outcome in mood disorders.
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Affiliation(s)
- A Serretti
- Istituto Scientifico Ospedale San Raffaele, Department of Neuropsychiatric Sciences, University of Milan School of Medicine, Italy.
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42
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Serretti A, Lorenzi C, Lilli R, Smeraldi E. Serotonin receptor 2A, 2C, 1A genes and response to lithium prophylaxis in mood disorders. J Psychiatr Res 2000; 34:89-98. [PMID: 10758249 DOI: 10.1016/s0022-3956(00)00004-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the influence of serotonin receptors 2A, 2C and 1A gene variants on lithium prophylactic efficacy in mood disorders. One hundred and twenty-four subjects affected by bipolar (n=102) and major depressive (n=22) disorder were followed prospectively for an average of 52 months and were typed for 5-HT2A (T102C: n=111, HTP: n=104), 5-HT2C (n=110) and 5-HT1A (n=61) variants. Both 5-HT2A and 5-HT2C variants were not associated with lithium outcome. Consideration of possible stratification effects like gender, polarity, family history, age at onset and duration of lithium treatment did not influence results. No 5-HT1A gene variant was identified. 5-HT2A and 2C variants are not, therefore, associated with lithium prophylactic efficacy in mood disorders.
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MESH Headings
- Adult
- Antimanic Agents/adverse effects
- Antimanic Agents/therapeutic use
- Bipolar Disorder/diagnosis
- Bipolar Disorder/drug therapy
- Bipolar Disorder/genetics
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/drug therapy
- Depressive Disorder, Major/genetics
- Female
- Follow-Up Studies
- Genetic Variation/genetics
- Genotype
- Humans
- Lithium Carbonate/adverse effects
- Lithium Carbonate/therapeutic use
- Male
- Middle Aged
- Receptor, Serotonin, 5-HT2A
- Receptor, Serotonin, 5-HT2C
- Receptors, Serotonin/drug effects
- Receptors, Serotonin/genetics
- Receptors, Serotonin, 5-HT1
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- A Serretti
- Istituto Scientifico Ospedale San Raffaele, Department of Neuropsychiatric Sciences, University of Milan School of Medicine, Italy.
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