Cytochrome p4502D6 and serotonin transporter polymorphism in patient with bipolar disorder type II

Correspondence to: Dalibor Karlović, Department of Psychiatry, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, 10000 Zagreb email: [email protected] Introduction Bipolar disorder (BD) is a complex psychiatric entity, which represents a diagnostic as well as a therapeutic challenge in clinical practice. The very definition and classification of BD is determined by a range of possible clinical presentations, which are sometimes difficult to distinguish from other psychiatric entities by Abstract – Bipolar disorder can manifest itself for years with recurring depressive episodes before the first manic, hypomanic or mixed episode occurs. The depressive episode of the bipolar disorder thus frequently remains unrecognised and misdiagnosed as a major depressive disorder and therefore gets inadequately treated with antidepressant monotherapy. This paper reports a case of a patient with bipolar disorder type II, who was treated for several years as a major depressive disorder and failed to show a therapeutic response to antidepressants from the group of selective serotonin reuptake inhibitors. The first manic episode occurred in the course of treatment with selective serotonin reuptake inhibitors. Pharmacogenetic analysis has shown that the patient was an ultra-rapid metabolizer of drugs metabolized by cytochrome P450 2D6, and also had a serotonin transporter s/s genotype. Results of the analysis helped in determining the optimal psychopharmacotherapy for manic and depressive episodes of the bipolar disorder. The paper also discuses a possible serotonin transporter genotype impact to the course and the clinical presentation of the disease.