New work by scientists at Duke University Medical Center could help predict patients' response to depression drugs with high accuracy, according to Pannochka, an online publication for girls and women aged 14 to 35.. net Researchers identify new biochemical changes in neurotransmitter pathways in people taking antidepressants. These changes occur in the pineal gland, the part of the endocrine system that controls sleep cycles.. This suggests a link between sleep, depression and treatment outcome..

Research in the field of pharmacometabolomics is carried out in order to determine the pathways of hundreds and thousands of drugs in the body, and to calculate the mechanisms of their action on certain systems.. Pharmacometabolomics helps to create new treatment strategies based on the metabolic profile of an individual patient.

Dr. Rima Kaddura-Dawk, an expert in psychiatry and behavioral sciences at Duke Medicine, says: “Pharmacometabolomics is the science of differences in patients’ metabolic profiles and how they affect the body’s response to treatment.. This science will help to find the right targets for the treatment of depression in each patient, and to understand which patient will respond to treatment and which will be resistant to it..

Depression is one of the major health problems in developed countries today.. In the United States, about 6.7% of the population as of 2013 suffer from depression, and in some northern European countries, this figure exceeds 10%.

Selective serotonin reuptake inhibitors (SSRIs, SSRIs) are the most commonly prescribed antidepressants, but experience shows that only a fraction of patients respond to such treatment.. Studies show that other patients experience relief from a placebo, while others do not help anything.. This variability in drug response creates difficulties for clinicians, and forces them to try different drugs, each time waiting for the result for several weeks..

The Duke Medicine team's latest study used state-of-the-art metabolomics tools to create a 'map' of the biochemical pathways involved in the development of depression, distinguishing different types of patients who will respond to different drugs.. These studies have identified several metabolites of the tryptophan metabolic pathway that may be potential factors influencing patient response..

Tryptophan is metabolized in different ways. One pathway leads to serotonin, melatonin, and several similar compounds called methoxyindoles, which are produced in the pineal gland.. In a new study, scientists analyzed the level of metabolites of different branches of the tryptophan pathway, and compared them with the outcome of antidepressant treatment..

75 patients with depression were randomized to receive sertalin (Zoloft) and placebo in a double-blind study.. After 1 and 4 weeks of SSRIs or placebo, the investigators assessed improvement in depressive symptoms and drew conclusions about participants' response to therapy.. At the same time, blood samples were taken for analysis on the level of neurotransmitters.

Approximately 60% of patients responded to SSRI treatment, with 50% of placebo patients also showing improvement. Those who took SSRIs and responded to treatment showed several characteristic changes in the tryptophan pathway.. No such changes were found in participants who did not respond to therapy..

The results suggest that the metabolism of serotonin in the pineal gland may play a role in the development of depression and influence the outcome of its treatment..

Dr. Kaddura-Dawk says: “This study has shown that the pineal gland is involved in the mechanisms of recovery from a depressive state.. We started to map serotonin pathways, but now we understand that not only serotonin itself is important in the process of recovery. It is possible that serotonin metabolites are also involved in this complex process.”.

Identification of the metabolic profile of patients will have a huge impact on the effectiveness of depression treatment in the future.. The Duke Medicine team first began to study the features of the action of antidepressants in such depth. In future work, the scientists plan to collect blood samples from patients during the day and at night to determine how SSRI treatment is affected by circadian rhythms, changes in sleep patterns and neurotransmitter levels during the day.. This will lead to the creation of new, more effective treatment regimens..

medbe. en.