RESUMOFundamentação/introdução: A Vareniclina é um medicamento utilizado como terapia antitabagista por atuar como agonista parcial seletivo dos receptores nicotínicos. Sua ação resulta em baixa a moderada liberação de dopamina na via mesolímbica, auxiliando no combate a sintomas de desejo e abstinência. Entretanto, esse fator também pode levar ao desenvolvimento de sintomas psicóticos, já bem relatados na população com distúrbios psiquiátricos prévios, mas com pouca correlação com os pacientes previamente hígidos.
This study aims to report the correlation of MTHFR gene mutation with the genesis of depression and antidepressants non-response in a patient, highlighting the importance of genetic investigation and indicating the replacement of L-methylfolate as an effective treatment adjuvant. This is a case report of a patient diagnosed with major depressive disorder, refractory to pharmacological therapies, in monotherapy or combination therapy, and psychotherapy. After 1 year and 4 months of persistent residual symptoms, genetic testing of the MTHFR gene was requested with confirmation of a heterozygous double mutation of MTHFR. This gene polymorphism can result in deficiency of L-methylfolate, which is related to psychiatric diseases and refractoriness to antidepressant therapy. With the introduction of l-methylfolate 15mg, the patient reported remission of depressive symptoms in 4 months of follow-up. MTHFR gene mutations influence the action of folate, favoring depression and leading to refractory response to conventional treatment.
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