New study: genetic variants in the monoamine system and CBT outcome in social phobia

In a collaboration between Karolinska Institutet and Uppsala University, we studied three genetic polymorphisms in the monoamine system (5-HTTLPR, COMT val158met, TPH2 G-703T) and outcome of cognitive behavioral therapy (CBT) in social anxiety disorder (SAD) in over 300 patients. This is one of the largest genetic studies ever made on adults with SAD and CBT outcome. Monoamine-related gene polymorphisms have previously been tied to amygdala reactivity, treatment efficacy and fear extinction processes and was hereby reasoned to influence the outcome of CBT. However, none of our polymorphisms were associated with CBT outcome at long term follow-up. In our subsamples we found contradictory significant effects immediately after treatment. Even though CBT is an effective treatment of anxiety disorders, many patients (25-50%) do not respond sufficiently. Therefore, there is a need to improve not only the treatments but also how patients are selected for treatment in order to optimize the efficacy. Therapygenetics attempts to explore the relationship between genetic variation and psychological treatment response. Ultimately, such knowledge could be used to tailor therapies based on patients’ biological markers, which in turn, could improve therapeutic outcome.

Lead author Evelyn Andersson.