From the Guidelines
Depression biotypes are a crucial aspect of personalized treatment, and identifying the specific biotype of a patient can significantly improve treatment outcomes by allowing for more targeted interventions. The concept of depression biotypes is based on the idea that different subtypes of depression are characterized by distinct biological markers, symptoms, and treatment responses 1. Researchers have identified several potential biotypes, including inflammatory depression, anxious depression, melancholic depression, and atypical depression. These classifications are still evolving as research progresses, with studies such as the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) providing valuable insights into the identification and management of depression in adolescents 1.
Some key points to consider when evaluating depression biotypes include:
- Inflammatory depression, marked by elevated inflammatory markers, may respond better to anti-inflammatory interventions alongside traditional antidepressants
- Anxious depression, characterized by high anxiety symptoms alongside depression, might benefit from medications that address both conditions, such as SNRIs like venlafaxine or duloxetine
- Melancholic depression, featuring anhedonia and psychomotor changes, and atypical depression, characterized by increased appetite and hypersomnia, require distinct treatment approaches
- The identification of depression biotypes aims to move beyond the traditional symptom-based diagnosis toward a more personalized approach to treatment, as recommended by guidelines such as those from the American College of Physicians 1
However, biotype testing is not yet standardized in clinical practice, and more research is needed to fully understand the implications of depression biotypes on treatment outcomes. Despite this, clinicians can use various tools, such as blood tests for inflammatory markers, brain imaging, and detailed symptom assessments, to help identify certain biotypes and provide more targeted treatments. Ultimately, the goal of identifying depression biotypes is to improve treatment outcomes and reduce the trial-and-error approach currently common in depression treatment, which is in line with the recommendations of recent studies 1.
From the Research
Depression Biotype
- Depression is a complex condition that affects over 300 million individuals worldwide, with various subtypes, including chronic, psychotic, catatonic, melancholic, seasonal, somatic, mixed, and atypical 2.
- The diagnosis of depression is traditionally made based on clinical criteria, including patient current symptoms and history, but newer diagnostic methods such as genomics, proteomics, and metabolomics are emerging 3.
- Selective serotonin-reuptake inhibitors (SSRIs) are a commonly used treatment for depression, with a good side-effect profile, tolerability, and safety in overdose, and are considered first-line medication in the management of major depression 4, 5.
- SSRIs have been shown to be efficacious in the treatment of chronic depression, with response rates comparable to tricyclic antidepressants (TCAs), but with better acceptability in terms of dropout rates 6.
- The strength of recommendation and level of evidence for depression treatment vary among clinical practice guidelines (CPGs), with some CPGs including recommendations for specific subtypes of depression, such as catatonic, atypical, and melancholic depression 2.
- Different SSRIs, such as sertraline, fluoxetine, and citalopram, have been developed and show promising results in delivering antidepressant activity, with ongoing research aimed at improving their efficacy and reducing side effects 5.