Farmacogenética na personalização do tratamento da depressão: revisão sistemática

Abstract

Introduction: Major depressive disorder (MDD), commonly referred to as depression, is currently the most prevalent mood disorder, often labeled as the “disease of modern society.” Adding to the severity of its symptoms is the fact that it is highly prevalent and debilitating. Despite significant advancements in various fields, its diagnosis remains challenging due to many factors. Thus, in an attempt to improve treatment response, the importance of pharmacogenetics emerges, as it aims to match the pharmacological profile of the medication to the patient's genetic profile to optimize prescription. Methodology: This is a systematic review of the literature. The search was carried out in the databases: PubMed and CAPES Periodicals. To direct the search, the descriptors: “pharmacogenetics”, “depression”, “Brazil” and “treatment-resistant depression” were used, through association with Boolean operators “AND”, as well as the following filters were applied: full text, in the last 10 years (2014-2024) and human, ultimately selecting 34 articles for this review. Results: Of the 34 articles selected, 15 aimed to answer whether pharmacogenetic tests affect the selection of antidepressant medications and 12 focused on the usefulness and clinical application of pharmacogenetics, as well as its cost-benefit. The remaining articles focused mainly on the most studied drugs and genes with the best results. Pharmacogenetic tests have significant potential to personalize and improve the treatment of depression, especially the remission rate and reduction of adverse drug interactions. However, the effectiveness of pharmacogenetic tests is not consistently significant across studies, and their benefits may depend on individual patient characteristics and the persistence of long-term effects. Studies with different professionals reveal concerns such as limited knowledge, impact on workflow and misinterpretation of results, but also highlight the usefulness of tests in patients with previous unsuccessful treatments. The use of pharmacogenetic testing in patients with multiple risk factors can prevent dangerous drug interactions and reduce medication costs and hospitalizations, despite the initial high cost. In the Brazilian context, implementation in the SUS faces financial and political challenges. Conclusion: Pharmacogenetics has significant potential to personalize and improve the treatment of depression, but there are still significant barriers to its implementation in clinical practice, requiring continued education of health professionals and the development of more research that demonstrates the effectiveness of adopting the genetic profile in the treatment of depression.