Determination of CYP2C19 polymorphism, side effects, and medication adherence in patients who have utilized selective serotonin reuptake inhibitors Objective: The aim of this study is to determine relationship of cytochrome P-450 2C19 (CYP2C19) enzymes polymorphism, side effects, and medication adherence in patients who have been diagnosed with major depression and have utilized selective serotonin reuptake inhibitors. Methods: Fifty-three major depression patients (mean of age: 33.25±11.29 years old; male/female: 7/46) were included in this study. Polymorphisms were determined from genomic DNA by using the 'Real-Time Polymerase Chain Reaction' method. Side effects and medication adherence levels were assessed by using the 'Toronto Side Effects Scale' and the four items medication adherence scale (Morisky, Green and Levine), respectively. Results: The most common side effects that patients reported were drowsiness/daytime somnolence (54.7%), malaise or fatigue (43.4%), sweating (43.4%), nausea (41.5%) and dry mouth (41.5%). Only nine (17%) patients were found to be highly adherent to their medication. When evaluating the CYP2C19 polymorphisms of patients, 37.7%, 24.5% and 20.8% of the patients were classified as intermediate, extensive and ultra-rapid metabolizers, respectively. Allele frequencies of CYP2C19*17 and CYP2C19*2 was calculated as 24.5% and 27.4%, respectively. Although there were some differences in side effect scores and medication adherences among the polymorphism groups, these relationships were not found to be statistically significant. Conclusion: This study shows that patients who utilized antidepressants frequently experienced side effects and had low medication adherence. Another interesting finding is the high rate of ultrarapid metabolizers of CYP2C19.

Suicide attempt by subcutaneous injection of cyanide: a case report Cyanide is a powerful poison which cause inhibition of mitochondrial cytochrome oxidase system. Cyanide poisining can present in a wide variety of forms such as inhalation, ingestion or injection. Dermal exposure is rare, very few case reports have been reported about cyanide. In this paper, we present an uncommon case of a suicide attempt with cyanide injection. A 91 year old man with a history of depression admitted to the emergency department after injected cyanide to himself subcutaneously. He was diagnosed with depressive disorder and hospitalized after psychiatric assessment. The psychiatric history of this patient suggests that depression in elderly can give way to serious suicides attempts. Psychiatrists interested in treatment of elderly depressed patients should do careful monitoring about suicide.