Review Article

Pharmacogenomics Can Enhance Prescribing of Psychiatric Medications

Authors: Puneet Narang MD, Amy Johnson MD, Manasa Enja MD, Steven Lippmann MD

Abstract

Many psychiatric patients experience pharmaceutical intolerances, and some of them do not derive optimal efficacy from their pharmacotherapies. Clinical problems such as these may result in prolonged dysfunction, adverse consequences, and repeated changes in medication treatment regimens. Pharmacogenomics is a laboratory method that aids individualized medication selection by predicting drug efficacy and adverse effect profiles. It is a technique that involves the testing of patients’ genetic makeup to improve medicinal response and tolerance. Pharmacogenomics aims to clarify pharmacokinetics and pharmacodynamics in addition to focusing on hepatic cytochrome enzyme metabolism. Ultimately, it facilitates optimal selection and adjustment of medications to enhance clinical outcomes. Pharmacogenomics is most useful in cases in which routinely prescribed pharmacotherapies are either suboptimally effective or have unacceptable adverse effects. Once there has been a failure of a therapeutic drug treatment, rather than “blindly” selecting an alternative medicine, pharmacogenomic test results can provide guidance for the selection of the most appropriate drug and its dose. The intent is to yield a greater likelihood of patient success in following a therapeutic intervention.

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References

1. Hall-Flavin DK, Winner JG, Allen JD, et al. Using a pharmacogenomic algorithm to guide the treatment of depression. Transl Psychiatry 2012;2:e172.
 
2. Reynolds GP, McGowan OO, Dalton CF. Pharmacogenomics in psychiatry: the relevance of receptor and transporter polymorphisms. Br J Clin Pharmacol 2014;77:654-672.
 
3. Sallee FR, DeVane CL, Ferrell RE. Fluoxetine-related death in a child with cytochrome P-450 2D6 genetic deficiency. J Child Adolesc Psychopharmacol 2000;10:27-34.
 
4. Smeraldi E, Zanardi R, Benedetti F, et al. Polymorphism within the promoter of the serotonin transporter gene and antidepressant efficacy of fluvoxamine. Mol Psychiatry 1998;3:508-511.
 
5. Serretti A, Kato M, De Ronchi D, et al. Meta-analysis of serotonin transporter gene promoter polymorphism (5-HTTLPR) association with selective serotonin reuptake inhibitor efficacy in depressed patients. Mol Psychiatry 2007;12:247-257.
 
6. Myung W, Lim SW, Kim S, et al. Serotonin transporter genotype and function in relation to antidepressant response in Koreans. Psychopharmacology (Berl) 2013;225:283-290.
 
7. Murphy GM, Jr Hollander SB, Rodrigues HE, et al. Effects of the serotonin transporter gene promoter polymorphism on mirtazapine and paroxetine efficacy and adverse events in geriatric major depression. Arch Gen Psychiatry 2004;61:1163-1169.
 
8. Lerer B, Segman RH, Tan EC, et al. Combined analysis of 635 patients confirms an age-related association of the serotonin 2A receptor gene with tardive dyskinesia and specificity for the non-orofacial subtype. Int J Neuropsychopharmacol 2005;8:411-425.
 
9. Hicks JK, Swen JJ, Thorn CF, et al. Clinical Pharmacogenetics Implementation Consortium guideline for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants. Clin Pharmacol Ther 2013;93:402-408.
 
10. Luminex. Package insert. https://www.luminexcorp.com/clinical/genetictesting/pharmacogenetics/cyp2d6. Accessed July 5, 2016.
 
11. Hamilton SP. The promise of psychiatric pharmacogenomics. Biol Psychiatry 2015;77:29-35.
 
12. de Leon J, Arranz MJ, Ruañ G. Pharmacogenetic testing in psychiatry: a review of features and clinical realities. Clin Lab Med 2008;28:599-617.
 
13. Kaplan A. Psychiatric pharmacogenomics. http://www.psychiatrictimes.com/articles/psychiatric-pharmacogenomics. Published December 12, 2011. Accessed July 5, 2016.
 
14. Thompson C, Hamilton SP, Hippman C. Psychiatrist attitudes towards pharmacogenetic testing, direct-to-consumer genetic testing, and integrating genetic counseling into psychiatric patient care. Psychiatry Res 2015;226:68-72.
 
15. Mrazek DA, Lerman C. Facilitating clinical implementation of pharmacogenomics. JAMA 2011;306:304-305.