Genetic Variation Predict Success in Anxiety and Depression Therapy


Researchers suggest that individual variation in genes alters our ability to regulate emotions, providing new insights that could help in the development of personalized therapies to tackle anxiety and depression.

Some individuals are at greater risk of developing anxiety and depression than others and this depends in part upon the interaction between our genes and our environment, such as stressful or adverse events in our lives. Moreover, some of those who develop anxiety or depression may respond better to treatment while others struggle to benefit.

A research team at University of Cambridge led by Professor Angela Roberts identified specific brain mechanisms in marmoset monkeys that may underlie how genetic variation in the serotonin transporter gene, a key gene that regulates mood and stress responses, can influence the way we respond to perceived threat. The work is now published in PNAS.

The research lab previously showed that the particular variant of the gene carried by a monkey will influence whether it perceives an ambiguous stimulus as being high or low threat. This characteristic of an individual’s personality is called “trait anxiety”.

High trait anxiety is a risk factor in humans for developing anxiety and mood disorders, and genetic variation in the serotonin transporter gene has been linked with an increased likelihood of developing these disorders.

In this earlier study which was published in Neuropsychopharmacology, the researchers showed that variants of the gene also affected how a monkey responds to certain medicines. Specifically, individuals carrying the variant of the gene associated with high anxiety actually increased their anxiety towards a threat immediately after treatment with a commonly used antidepressant—selective serotonin re-uptake inhibitor, or SSRI. This so-called “anxiogenic” effect is often seen in patients in the early stages of treatment and is thought to be part of the reason why these patients do not respond favorably to SSRIs.

In this new PNAS study, the researchers have revealed how variation in the serotonin transporter gene has an impact on the number of a specific type of serotonin receptor, known as the type 2A receptor, in a specific brain area. Monkeys carrying the variant of the gene associated with high anxiety had lower numbers of this receptor, hence changing the way in which serotonin-based drugs act upon them.

“Genetic variation in the serotonin transporter gene (SLC6A4) is associated with vulnerability to affective disorders and alterations in the efficacy of pharmacological treatment. We recently identified sequence polymorphisms in the common marmoset SLC6A4 repeat region (AC/C/G and CT/T/C) associated with individual differences in trait anxiety, gene expression, and response to antidepressants. The mechanisms underlying the effects of these polymorphisms are unknown, but a key mediator of serotonin action is the serotonin 2A receptor (5HT2A). Thus, we correlated 5HT2A binding potential (BP) and postmortem RNA gene expression in 16 SLC6A4 genotyped marmosets with responsivity to 5HT2A antagonism during the human intruder test of anxiety. Voxel-based analysis and RNA measurements showed a reduction in 5HT2A BP and gene expression specifically in the right posterior insula of individuals homozygous for the anxiety-related variant AC/C/G. These same marmosets displayed an enhanced anxiety-related, dose-dependent response to the human intruder after 5HT2A pharmacological antagonism, whilst CT/T/C individuals showed no effect,” the investigators wrote.

“A voxel-based correlation analysis, independent of SLC6A4 genotype, revealed that 5HT2A BP in the adjacent right anterior insula and insula proisocortex was negatively correlated with trait anxiety scores. Moreover, 5HT2A BP in both regions were good predictors of the size and direction of the acute emotional response to the human intruder threat after 5HT2A antagonism. Our findings suggest that genetic variation in the SLC6A4 repeat region may contribute to the trait anxious phenotype via neurochemical changes in brain areas implicated in interoceptive and emotional processing, with a critical role for the right insula 5HT2A in the regulation of affective responses to threat.”

Medicines targeting serotonin 2A receptors have recently been used in the treatment of anxiety and mood disorders, so these findings suggest that it could be important in the future to know what variant of the serotonin transporter gene an individual is carrying when deciding on a treatment strategy.

The specific brain area where the number of receptors was reduced was the insula cortex, an important site for integrating information about sensations coming from the body with cognitive information processed in other areas to generate feelings and self-awareness, and to help guide decision-making.

This new finding suggests that those cognitive behavioral therapies (CBT) that focus on controlling sensations from the body could help patients in whom SSRI drugs are not effective.

The study suggests that differences in gene variation may help predict which of us will respond well to these medicines and which of us require a different approach. This could be assessed using genetic testing.”

Genetic Variation Predict Success in Anxiety and Depression Therapy - Medicine Innovates

About the author

Professor Angela Roberts received her degree in Neurobiology from the University of Sussex and her PhD in neuroendocrine control of reproduction from the University of Cambridge under the supervision of Joe Herbert in the Department of Anatomy. She stayed on in Cambridge and did her postdoctoral training in the Department of Experimental Psychology with Trevor Robbins where she held a Royal Society Research Fellowship from 1992-96. She then took up a teaching appointment in the Department of Anatomy and there began her studies on the prefrontal control of emotion regulation.

Currently she undertakes the scientific leadership of the marmoset research centre at Cambridge and is Chair of the steering committee for a new Laboratory of Translational Neuroimaging. She also sits on the Executive committee of Cambridge Neuroscience.

She is currently an associate editor for Frontiers in Behavioral Neuroscience, a field Editor for the International Journal of Neuropsychopharmacology and sits on the council of the British Association of Psychopharmacology. In 2016 she was elected to the Fellowship of the Academy of Medical Sciences.

Professor Roberts is interested in the neural circuits underlying the regulation of cognition and emotion of relevance to our understanding of a variety of neuropsychiatric and neurodegenerative disorders. In particular her lab focusses on the prefrontal control of subcortical circuitry involved in processing positive and negative emotions, both in adulthood and more recently in development. The overall aim is to fractionate the neurocognitive circuits that underlie the regulation of emotion and to relate them to the distinct symptoms of emotion dysregulation present, not only in anxiety and depression, but also schizophrenia, autism and neurodegenerative disorders, such as Parkinson’s disease. The lab is also interested in the relationship of activity in these neurocognitive circuits with individual differences in behavioural phenotypes, e.g. trait anxiety, and genotypes, during development as well as in adulthood.


Andrea M. Santangelo, Steve J. Sawiak, Tim Fryer, Young Hong, Yoshiro Shiba, Hannah F. Clarke, Patrick J. Riss, Valentina Ferrari, Roger Tait, John Suckling, Franklin I. Aigbirhio, and Angela C. Roberts. Insula serotonin 2A receptor binding and gene expression contribute to serotonin transporter polymorphism anxious phenotype in primates. PNAS 2019 116 (29) 14761-14768;