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Pharmacopsychiatry 2011; 44(06): 263-272
DOI: 10.1055/s-0031-1286290
Original Paper
Georg Thieme Verlag KG Stuttgart · New York

Predicting Response to Psychopharmacological Treatment: Survey of Recent Results[ *]

H. Stassen
1   Psychiatric University Hospital Zurich, Research Group ‘Psychiatric Genetics’, Zurich, Switzerland
,
I.- Anghelescu
2   Janssen Pharmaceutica, Beerse, Belgium
,
J. Angst
1   Psychiatric University Hospital Zurich, Research Group ‘Psychiatric Genetics’, Zurich, Switzerland
,
H. Böker
1   Psychiatric University Hospital Zurich, Research Group ‘Psychiatric Genetics’, Zurich, Switzerland
,
K. Lötscher
1   Psychiatric University Hospital Zurich, Research Group ‘Psychiatric Genetics’, Zurich, Switzerland
,
D. Rujescu
3   Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
,
A. Szegedi
4   Schering-Plough Research Institute, New Jersey, USA
,
C. Scharfetter
1   Psychiatric University Hospital Zurich, Research Group ‘Psychiatric Genetics’, Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

received 27 December 2010
revised 15 March 2011

accepted 26 April 2011

Publication Date:
28 September 2011 (online)

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Abstract

Introduction:

Treatment with antidepressants and antipsychotics, though effective, is unspecific as agents that differ greatly in their biochemical and pharmacological actions have virtually the same efficacy. Half of the patients with initial improvement show incomplete response, while a large proportion of patients exhibit a refractory clinical picture which is resistant to all treatment modalities.

Methods:

Our analyses were based on a reference study of 2 848 depressive inpatients under monotherapeutic treatment with 7 different antidepressants or placebo, along with a naturalistic study of depressive and schizophrenic patients (296 inpatients, 363 outpatients) under today’s “standard” polypharmaceutic treatment regimens.

Results:

The empirical data suggested the following predictors of response: (1) severity at baseline, (2) early onset of improvement, (3) unwanted side-effects, and (4) medical comorbidity. A combination of these predictors with Therapeutic Drug Monitoring (TDM) methods has direct clinical relevance.

Discussion:

Evidence-based approaches to personalized treatment help improving the unsatisfactory situation patients and clinicians are faced with, given today’s incomplete treatments and the fact that the mechanisms by which antidepressants and antipsychotics ultimately exert their therapeutic effects are only marginally understood.

Key words

TDM - severity at baseline - early onset - side-effects - medical comorbidity - polypharmacy - inflammatory processes
*

* These data were presented during the Congress of the TDM group of the AGNP in Bolzano 2010 in Italy during a special lecture by Hans H. Stassen to honour Prof. Dr. Bruno Müller-Oerlinghausen who supported TDM in psychiatry effectively for many years.


 

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