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The Promise of Psychiatric Pharmacogenomics

  • Steven P. Hamilton
    Correspondence
    Address correspondence to Steven P. Hamilton, M.D., Ph.D., Department of Psychiatry, Kaiser Permanente San Francisco Medical Center, 4141 Geary Boulevard, 3rd Floor, San Francisco, CA 94118.
    Affiliations
    Department of Psychiatry, Kaiser Permanente San Francisco Medical Center, San Francisco, California
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Published:September 24, 2014DOI:https://doi.org/10.1016/j.biopsych.2014.09.009

      Abstract

      Clinicians already face “personalized” medicine every day while experiencing the great variation in toxicities and drug efficacy among individual patients. Pharmacogenetics studies are the platform for discovering the DNA determinants of variability in drug response and tolerability. Research now focuses on the genome after its beginning with analyses of single genes. Therapeutic outcomes from several psychotropic drugs have been weakly linked to specific genetic variants without independent replication. Drug side effects show stronger associations to genetic variants, including human leukocyte antigen loci with carbamazepine-induced dermatologic outcome and MC4R with atypical antipsychotic weight gain. Clinical implementation has proven challenging, with barriers including a lack of replicable prospective evidence for clinical utility required for altering medical care. More recent studies show promising approaches for reducing these barriers to routine incorporation of pharmacogenetics data into clinical care.

      Keywords

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