Serotonin Transporter Gene Promotor Polymorphism (5-HTTLPR) Associations with Number of Psychotropic Medication Trials in a Tertiary Care Outpatient Psychiatric Consultation Practice

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• 作者：James R. Rundell ; M.D. ; ^{rundell.james@mayo.edu} ; Jeffrey P. Staab ; M.D. ; M.S. ; Gen Shinozaki ; M.D. ; Donald McAlpine ; M.D.
• 刊名：Psychosomatics
• 出版年：2011
• 出版时间：March-April 2011
• 年：2011
• 卷：52
• 期：2
• 页码：147-153
• 全文大小：140 K

文摘

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Objective

The authors tested the hypothesis that the short allele of 5-HTTLPR is associated with number of psychotropic medication trials as a measure of treatment-resistance or intolerance in psychosomatic medicine (PM) outpatients.

Methods

Review of Mayo Clinic PM outpatient 2008 records identified 44 (20.6 % ) who had 5-HTTLPR genotype tests. A univariate analysis screened for factors that could account for number of medication trials. Logistic regression then determined degree of association between 5-HTTLPR genotype category and number of pharmacological trials.

Results

Univariate analysis revealed significant differences across the ordinal genotype spectrum long/long, short/long, short/short in mean number of overall psychotropic medication trials (8.9, 14.8, 18.0, P = 0.002), mean number of antidepressant trials (4.3, 7.2, 8.1, P = 0.018), mean number of mood stabilizer trials (0.8, 1.9, 2.3, P = 0.008), percent living alone (7 % , 25 % , 50 % , P = 0.020), reported family history of depression (93 % , 65 % , 40 % , P = 0.006), and reported family history of chemical dependency treatment (50 % , 35 % , 10 % , P = 0.050). There were trends for differences in consultation reason for unexplained symptoms (14 % , 25 % , 50 % , P = 0.063), and diagnoses of somatoform disorder (7 % , 30 % , 40 % , P = 0.060), and generalized anxiety disorder (43 % , 65 % , 80 % , P = 0.064). After controlling for other differences, presence of the short allele remained associated with number of psychotropic medication trials (OR 4.779, 95 % CI 2.263?.771, P = 0.004), and number of antidepressant trials (OR 1.591, 95 % CI 1.072?.762, P = 0.019).

Conclusion

5-HTTLPR testing may identify PM outpatients at higher relative risk for pharmacotherapy treatment non-response or intolerance who may benefit from alternative or augmentative medication recommendations or non-pharmacological interventions.