Personalized Psychiatry and Depression: The Role of Sociodemographic and Clinical Variables

Abstract

Despite several pharmacological options, the clinical outcomes of major depressive disorder (MDD) are often unsatisfactory. Personalized psychiatry attempts to tailor therapeutic interventions according to each patient’s unique profile and characteristics. This approach can be a crucial strategy in improving pharmacological outcomes in MDD and overcoming trial-and-error treatment choices. In this narrative review, we evaluate whether sociodemographic (i.e., gender, age, race/ethnicity, and socioeconomic status) and clinical [i.e., body mass index (BMI), severity of depressive symptoms, and symptom profiles] variables that are easily assessable in clinical practice may help clinicians to optimize the selection of antidepressant treatment for each patient with MDD at the early stages of the disorder. We found that several variables were associated with poorer outcomes for all antidepressants. However, only preliminary associations were found between some clinical variables (i.e., BMI, anhedonia, and MDD with melancholic/atypical features) and possible benefits with some specific antidepressants. Finally, in clinical practice, the assessment of sociodemographic and clinical variables considered in our review can be valuable for early identification of depressed individuals at high risk for poor responses to antidepressants, but there are not enough data on which to ground any reliable selection of specific antidepressant class or compounds. Recent advances in computational resources, such as machine learning techniques, which are able to integrate multiple potential predictors, such as individual/ clinical variables, biomarkers, and genetic factors, may offer future reliable tools to guide personalized antidepressant choice for each patient with MDD.

‘Precision’ or ‘personalized’ psychiatry: different terms – same content?

“…In the work of Perna and colleagues (2020), personalized psychiatry is defined as 'an approach to prevention and treatment of medical and psychiatric diseases, advocates tailoring health care to each individual by integrating genetics and epigenetics, brain imaging, clinical aspects and environmental factors, can be an answer to these needs. In fact, the aim is to predict more accurately illness susceptibility and to tailor the most effective treatment for each individual' [14]. Contrastingly, in the study performed by of Salagre and colleagues (2018), precision psychiatry was defined as something '.…”

“…For example, the World Federation for Mental Health has registered how, among various psychiatric disorders, depression is one of the main global causes for disability, and estimates that by 2030, it will presumably reach the top spot. This will, consequently, entail a substantial loss of productivity by those who suffer from this condition "in terms of disability-adjusted life years (DALYs) [14]. Treating depression requires vast financial resources, as do other psychiatric disorders; hence it profoundly affects public spending.…”

“…In fact, despite the initial clarification of some mechanisms for psychiatric disorders, the whole group of brain-related psychiatric disorders remains in need of significant elucidation. This represents a plausible reason for the high rate of unsatisfactory responses to therapy, like that in major depressive disorder which is heterogeneous in respect to symptom presentation and its underlying mechanisms [14,27]. Currently, there have been no significant advances in therapy unlike other conditions that succeeded in tumor treatment [4].…”

“…Treatment compliance rates, as well as the rehabilitation process and various aspects of psychiatric patient care, mostly focus on improving the patient's quality of life [12]. Despite scientific progress and existing therapies, to the present day, there has not been a definitive cure for most cases: Between 30 and 53 % of depressed patients undergo a full remission after antidepressant treatment [14] and between 30 and 70 % of anxiety disorders [34] cases fail to respond to the first pharmacologic intervention and, thus, cause a significant increase in morbidity and mortality rates, cost of care, and deterioration in their quality of life. Clinicians may attempt to control the symptomatology and, partially, the course of the disease [14].…”

“…Despite scientific progress and existing therapies, to the present day, there has not been a definitive cure for most cases: Between 30 and 53 % of depressed patients undergo a full remission after antidepressant treatment [14] and between 30 and 70 % of anxiety disorders [34] cases fail to respond to the first pharmacologic intervention and, thus, cause a significant increase in morbidity and mortality rates, cost of care, and deterioration in their quality of life. Clinicians may attempt to control the symptomatology and, partially, the course of the disease [14]. The relationship with the patient is also crucial to treatment adherence as reported in the meta-analysis by Totura and colleagues [35], which evaluated the impact of the therapeutic relationship on the pharmacologic treatment's outcome.…”