Biomarker Studies And The Future Of Personalized Treatment For Depression: Commentary: Biomarkers And Personalized Treatment

Oquendo, Maria A.; McGrath, Patrick; Weissman, Myrna M.

Although the efficacy for numerous antidepressant medications against placebo or no treatment for the acute and maintenance treatment of depression is well established, remission rates are low. Further, it is not possible to tell which of the many antidepressants are appropriate for which patient, since individual responses to specific treatments vary widely. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study found that only about one-third of patients went into remission using standard antidepressant medication after 3 months. Although other medications were tried for those who did not go into remission after a first round of antidepressant treatment, only 50–60% were in remission after 1 year. Similarly, oftentimes in the clinic, treatment is carried out for many months until the right treatment is found.

The last decade saw a number of large-scale practical trials conducted to answer questions about the overall efficacy of standard treatment. Certainly, determining efficacy on a group basis is important. However, that a medication is superior to placebo or no treatment for groups of patients does not mean it will be effective for a particular patient. Alternately, just because the medication is not effective at a group level, it does not mean the medication will not be effective for a given person. The problem, then, is that the clinician does not have a way of personalizing therapeutic strategies for individual patients.

Making medical therapeutics more precise will require development of strategies for identification of specific individuals likely to respond to a given intervention. Most recently, increased precision in psychiatry has been pursued through the search for biomarkers. A National Institute of Health workgroup defined biomarkers as characteristics that are objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. It is the latter type of biomarker that can improve outcomes by permitting treatment selection based on a patient's biological or other objectively measured traits.


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Depression and Anxiety

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February 1, 2022