Stratifying depression treatment

According to King’s College London, half of all depressed patients do not respond to first-line antidepressants. Until now, the only way to find out is with a trial-and-error approach – the patient has to try one antidepressant after the other for months or even years. The college’s scientists took a more personalised approach. With the help of a blood test, they want to determine which patients would respond to frequently used drugs, and which would need a more aggressive approach.

According to the study published in the International Journal of Neuropsychopharmacology, the researchers measured two biomarkers that indicate blood inflammation: Macrophage Migration Inhibitory Factor (MIF) and interleukin (IL)-1?. Previous studies have already shown that elevated levels of inflammation are associated with poor response to antidepressants.

The scientists found that they could pinpoint a threshold and precisely predict which patients would respond to conventional antidepressants. None of the patients with MIF and IL-1? levels above the threshold responded to the antidepressants most often prescribed. Those with inflammation levels below the threshold would likely respond, the study authors said.

“This study provides a clinically-suitable approach for personalising antidepressant therapy – patients who have blood inflammation above a certain threshold could be directed toward earlier access to more assertive antidepressant strategies, including the addition of other antidepressants or anti-inflammatory drugs,” explained senior author Carmine Pariante.