Modern views on therapy with antidepressants on the background of their individual pharmacogenetics

Annotation. In conducting pharmacotherapy, it is necessary to consider the genetic polymorphism of cytochromes P450, especially when receiving an inadequate response to treatment. Martial law in Ukraine contributed to an increase in the use of antidepressants. When prescribing antidepressants, the genetic polymorphism of their metabolism should be taken into account. The aim of the review is a generalization of modern international ideas regarding the selection, appointment, effectiveness control, and safety forecast in the pharmacotherapy of depressive states with antidepressants of different groups. An analytical search was conducted in international information sources and PubMed scientific database regarding the peculiarities of the use of antidepressants in various categories of patients. The review presents the results of the study of genetic polymorphism of cytochrome P450 in pregnant women and different age groups, they also differ in different countries, especially when using certain groups of antidepressants, which have differences in metabolism due to the effects of cytochrome P450. During pharmacogenomic testing (PGx), it is desirable to take into account the presence of slow, intermediate, normal, fast, and ultrafast types of metabolizes CYP2D6 and CYRS19. Selective serotonin reuptake inhibitors were used as first-line therapy in studies of pregnant women. Metabolism of paroxetine is carried out mainly by CYR2D6, citalopram, escitalopram, and certralin - CYR2C19 enzymes. It is known that pregnancy can increase the activity of CYR2D6 by 25-200%, and CYR2C19, on the contrary, decreases it by 50%. Assessment of the rate of metabolism of antidepressants against the background of slow or intermediate allelic variants of the cytochrome P450 genotype can increase the risks of toxicity of their use. Clarification of these problems remains a promising direction of future analysis in relevant populations, against the background of various physiological states of the body and differences in the course of depression.