Evaluation of CYP2C19 Phenotype Impact on Sertraline Treatment of Major Depressive Disorder

Abstract

Treatment for Major Depressive Disorder (MDD) has classically involved selective-serotonin reuptake inhibitors (SSRIs), but the appropriate selection of a specific pharmacologic has remained elusive. Clinical response to an SSRI can be predicted by clinical improvement within weeks of treatment initiation, but for many patients, clinical improvement is never identified. Recent research demonstrates an association between pharmacokinetics of SSRIs and the metabolizer phenotype of their associated cytochromes. In this retrospective chart review, we investigated 94 adult patients who were diagnosed with a depressive disorder and prescribed sertraline. Each patient’s clinical response to sertraline, as determined by clinician judgment, was recorded and evaluated with respect to the patient’s CYP2C19 metabolizer phenotype. We hypothesized that adult patients who are CYP2C19 ultra-rapid metabolizers and rapid metabolizers (UM+RM) did not experience response with sertraline when compared to patients who are CYP2C19 normal metabolizers (NM). We found no significant difference in clinical response between UM+RM and NM patients, and therefore patients may not benefit from preemptive pharmacogenomic testing for their CYP2C19 metabolism phenotype.