OBJECTIVE:Generalized anxiety disorder (GAD) is common in older adults and can be treated with selective serotonin reuptake inhibitors (SSRIs). Genetic variation in the serotonin transporter gene promoter region is posited to be associated with SSRI efficacy: 2 polymorphisms (5-HTTLPR S/L and rs25531 g/a) form a haplotype with the La combination having higher transcription activity than other haplotypes. We hypothesized that GAD patients with no La haplotypes (La⁻) have lower SSRI treatment efficacy than those with 1 to 2 La haplotypes (La+). METHOD: The study enrolled subjects aged 60 years or older with a principal diagnosis of GAD into a 12-week, randomized trial ofescitalopram versus placebo. One hundred fifty subjects were genotyped for the serotonin transporter promoter region haplotype and were divided into La⁻ and La+ genotype groups; the primary analyses were done in European Americans only (n = 125; n = 59 with escitalopram and n = 66 with placebo). RESULTS:Escitalopram had no efficacy in the La⁻ group versus moderate efficacy in the La+ group. This genetic moderation of SSRI efficacy was due to a higher placebo response in La⁻ subjects, compared with La+ subjects. Drug concentration did not affect the genetic results. Exploratory analyses suggest that La⁻ subjects had greater variability of anxiety symptoms unrelated to treatment. CONCLUSIONS: The serotonin transporter promoter haplotype is associated with variability in SSRI efficacy for late-life GAD. The variability may result from a genetic effect on anxiety symptom variability unrelated to treatment, rather than a pharmacodynamic effect that has been previously assumed. Further research is needed to understand the pharmacogenetic mechanism of this haplotype.
RCT Entities:
OBJECTIVE: Generalized anxiety disorder (GAD) is common in older adults and can be treated with selective serotonin reuptake inhibitors (SSRIs). Genetic variation in the serotonin transporter gene promoter region is posited to be associated with SSRI efficacy: 2 polymorphisms (5-HTTLPR S/L and rs25531 g/a) form a haplotype with the La combination having higher transcription activity than other haplotypes. We hypothesized that GAD patients with no La haplotypes (La⁻) have lower SSRI treatment efficacy than those with 1 to 2 La haplotypes (La+). METHOD: The study enrolled subjects aged 60 years or older with a principal diagnosis of GAD into a 12-week, randomized trial of escitalopram versus placebo. One hundred fifty subjects were genotyped for the serotonin transporter promoter region haplotype and were divided into La⁻ and La+ genotype groups; the primary analyses were done in European Americans only (n = 125; n = 59 with escitalopram and n = 66 with placebo). RESULTS:Escitalopram had no efficacy in the La⁻ group versus moderate efficacy in the La+ group. This genetic moderation of SSRI efficacy was due to a higher placebo response in La⁻ subjects, compared with La+ subjects. Drug concentration did not affect the genetic results. Exploratory analyses suggest that La⁻ subjects had greater variability of anxiety symptoms unrelated to treatment. CONCLUSIONS: The serotonin transporter promoter haplotype is associated with variability in SSRI efficacy for late-life GAD. The variability may result from a genetic effect on anxiety symptom variability unrelated to treatment, rather than a pharmacodynamic effect that has been previously assumed. Further research is needed to understand the pharmacogenetic mechanism of this haplotype.
Authors: Xian-Zhang Hu; Robert H Lipsky; Guanshan Zhu; Longina A Akhtar; Julie Taubman; Benjamin D Greenberg; Ke Xu; Paul D Arnold; Margaret A Richter; James L Kennedy; Dennis L Murphy; David Goldman Journal: Am J Hum Genet Date: 2006-03-28 Impact factor: 11.025
Authors: Josien Schuurmans; Hannie Comijs; Paul M G Emmelkamp; Chad M M Gundy; Ingrid Weijnen; Marcel van den Hout; Richard van Dyck Journal: Am J Geriatr Psychiatry Date: 2006-03 Impact factor: 4.105
Authors: R O'Hara; C M Schröder; R Mahadevan; A F Schatzberg; S Lindley; S Fox; M Weiner; H C Kraemer; A Noda; X Lin; H L Gray; J F Hallmayer Journal: Mol Psychiatry Date: 2007-03-13 Impact factor: 15.992
Authors: Carlos Israel Pérez Benítez; Kevin Smith; Russell G Vasile; Richard Rende; Maria Orlando Edelen; Martin B Keller Journal: Am J Geriatr Psychiatry Date: 2008-01 Impact factor: 4.105
Authors: Kathleen C Gunthert; Tamlin S Conner; Stephen Armeli; Howard Tennen; Jonathan Covault; Henry R Kranzler Journal: Psychosom Med Date: 2007-10-17 Impact factor: 4.312