Personalized medicine in Alzheimer's disease and depression

Abstract

Latest research in the mental health field brings new hope to patients and promises to revolutionize the field of psychiatry. Personalized pharmacogenetic tests that aid in diagnosis and treatment choice are now becoming available for clinical practice. Amyloid beta peptide biomarkers in the cerebrospinal fluid of patients with Alzheimer's disease are now available. For the first time, radiologists are able to visualize amyloid plaques specific to Alzheimer's disease in live patients using Positron Emission Tomography-based tests approved by the FDA. A novel blood-based assay has been developed to aid in the diagnosis of depression based on activation of the HPA axis, metabolic, inflammatory and neurochemical pathways. Serotonin reuptake inhibitors have shown increased remission rates in specific ethnic subgroups and Cytochrome P450 gene polymorphisms can predict antidepressant tolerability. The latest research will help to eradicate "trial and error" prescription, ushering in the most personalized medicine to date. Like all major medical breakthroughs, integration of new algorithms and technologies requires sound science and time. But for many mentally ill patients, diagnosis and effective therapy cannot happen fast enough. This review will describe the newest diagnostic tests, treatments and clinical studies for the diagnosis and treatment of Alzheimer's disease and unipolar, major depressive disorder.

Keywords: 5-HTT; 5-HTTLPR; 5-Hydroxytryptamine Transporter gene; AD; ADNI; ADRDA; Alzheimer's Disease Neuroimaging Initiative; Alzheimer's Disease and Related Disorders Association; Alzheimer's disease; Aβ40; Aβ42; CREB; CSF; CT; CV; CYP2C19; CYP2D6; CYP450; Coefficient of Variation; Computed Tomography; Cytochrome P450; Cytochrome P450 2C19; Cytochrome P450 2D6; DNA; DSM; DSM-IV-TR; DSM-V; Deoxyribonucleic Acid; Depression; Diagnostic and Statistical Manual of Mental Disorders; Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition; Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition-Text Revision; ELISA; Enzyme-Linked Immunosorbent Assay; Epigenetics; FDA; FK506-binding protein; FKBP5; Food and Drug Administration; GRIA; GRIK; HPA; IL28RA; KCNK2; MDDScore; MRI; MTC; Magnetic Resonance Imaging; Major Depressive Disorder Score; Methylthioninium Chloride; NINCDS; National Institute of Neurological and Communicative Disorders and Stroke; P-tau181P; PAPLN; PET; Personalized medicine; Positron Emission Tomography; QC; Quality Control; RDoC; RNA; Research Domain Criteria; Ribonucleic Acid; SSRI; STAR*D; Selective Serotonin Reuptake Inhibitor; Sequenced Treatment Alternatives to Relieve Depression; Serotonin-Transporter-Gene-Linked Polymorphic Region; T-tau; Tau phosphorylated at threonine 181; VNTR; WHO; World Health Organization; beta-amyloid, amino acids 1–40; beta-amyloid, amino acids 1–42; cAMP response element-binding protein; cerebrospinal fluid; glutamate receptor, ionotropic, AMPA; glutamate receptor, ionotropic, kainate; hypothalamic–pituitary–adrenal; interleukin 28 receptor, alpha (interferon, lambda receptor); papilin, proteoglycan-like sulfated glycoprotein; potassium channel, subfamily K, member 2; total Tau; variable nucleotide terminal repeat.