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Could Personalized Medicine Work in MDD Treatment and Prevent TRD?

Masaki Kato

Department of Neuropsychiatry, Kansai Medical University, Japan

Background/Objective: Major depressive disorder is a debilitating disease that imposes significant
social and economic burdens. Selective serotonin reuptake inhibitors (SSRIs) treatment was
introduced years ago and reduced morbidity of major depressive disorder with a favorable side effect
profile. However, unfortunately, not all individuals benefit from treatment and 30-40% of patients do
not show a complete response to treatment. Clinical guideline does not show which antidepressant is
the most appropriate to the patient just in front of you in clinical setting but simply suggest 'use the
new antidepressant such as SSRI, SNRI, mirtazapine as first line therapy' or 'be vigilant for side
effect'. Ranking of antidepressant to detect the best drug for all depressed patient in the world that is,
“the best generalized medicine” might be one solution. On the other hand, personalized medicine
based on some predictor to detect the most appropriate pharmacotherapy of each patient could be
another solution especially for psychiatric specialist. Substantial efforts were continuously devoted to
find the definitive marker including genetic factors that could predict antidepressant response for
personalized medicine; however, the growing body of research in this field and heterogeneity across
those studies could make it difficult for these candidates to be translated into treatment
recommendations.

In this presentation, I provide the considerable evidence such as meta-analysis, guideline and double
blind randomized controlled trial to detect the most appropriate pharmacotherapy as first-line and
second or later therapy including treatment resistant depression from the some specific factors point
of view; specific feature of symptom, ethnicity and genetic feature.

Conclusion: Combination therapies with different antipsychotic agents, which have different
mechanisms, are effective and rational, but their risks and benefits should be carefully considered
before treatment.