We propose here to explore systematically the association between drug-metabolizing enzymes activity assessed by a phenotypical approach and antidepressant plasma concentration, efficacy and tolerance in the clinical setting. During one year, patients receiving antidepressant will be included in tis prospective clinical, naturalistic and descriptive pilot study.
* Objectives To describe drug metabolism variability in depressive patients using a phenotypic approach * Study design Prospective, clinical, naturalistic, descriptive study During a consultation with their clinician, depressive patients will receive information. During the visit V0 with an investigator: patients will be included: * Verification of inclusion and non inclusion criteria * Reminder participation conditions * Inclusion, signature of consent * Collection of clinical and demographic features Between V0 and V1, for patients with change in antidepressant therapy, will take place telephone interviews every two weeks, conducted by the clinician to evaluate treatment depression response (tolerance and efficacy) During the visit V1, will take place: * Phenotypic study * Genetic study * Dosage of current antidepressant drug * Clinical evaluation: efficacy and tolerance * Number of patients During one year, the protocol will be proposed to all patients with depression and decision of change in antidepressant therapy, and all patients with stability od prescription since almost 6 weeks. The inclusion of approximately 100 patients is expected. * Name of the finished product Zyban®, Froben®, Antra®, Bexine®, Dormicum® Telfast® * Name of the active substance Omeprazole (10 mg, A02BC01) Caffeine (50 mg, N06BC01) Flurbiprofen (10 mg, M01AE09) Dextromethorphan (10 mg, R05DA09) Midazolam (1 mg, N05CD08) Fexofenadine (25mg, R06AX26 ) Bupropion (20 mg, N06AX12) * Duration of treatment One time during the study, one day (Visit 1) * Time plan of research -Duration for the patient: The study will stop when the patient has performed the V1 study Minimal delay between V0 and V1: 6 weeks (5-7 weeks) : for patient with decision to change the treatment, 5 days for patients with stability of treatment since almost 6 weeks. Maximal delay of participation for the patient: 4 months even when V1 was not performed -Overall duration of inclusion: one year Maximal overall duration of the study: 12 months+4 months= 16 months Maximal duration for the analytical study since the beginning of the study= 16 months+6 months: 22 months. Maximal delay for communication of the results: 2 years after the beginning of the study
Study Type
INTERVENTIONAL
Allocation
NA
Masking
NONE
Enrollment
100
The cocktail of drug substrates will be given one time, one day during the study, to explore the activity of CYP 1A2, 2B6, 2C9, 2C19, 3A4, 2D6, and the P-gp
Hôpitaux Universitaires de Genève
Geneva, Switzerland
RECRUITINGCYP1A2 activity
paraxanthine/caffeine
Time frame: >two hours after an oral intake of the cocktail probe drugs
CYP2B6 activity
4-hydroxybupropion/ bupropion
Time frame: >two hours after an oral intake of the cocktail probe drugs
CYP2D6 activity
dextrorphan / dextromethorphan
Time frame: >two hours after an oral intake of the cocktail probe drugs
CYP2C9 activity
4-hydroxyflurbiprofen/ flurbiprofen
Time frame: >two hours after an oral intake of the cocktail probe drugs
CYP2C19 activity
5-hydroxyomeprazole/ omeprazole
Time frame: >two, three and six hours after an oral intake of the cocktail probe drugs
CYP3A4 activity
1-hydroxymidazolam/ midazolam
Time frame: >two hours after an oral intake of the cocktail probe drugs
P-gp activity
Limited sampling fexofenadine AUC
Time frame: >two, three and six hours after an oral intake of the cocktail probe drugs
Antidepressant Concentration
Time frame: almost 6 weeks after the last treatment change
Antidepressant tolerance
FISBER test
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Time frame: almost 6 weeks after the last treatment change
Antidepressant efficacy
Tests: MADRS, Hamilton, QIDS-16
Time frame: almost 6 weeks after the last treatment change