Pharmacogenomics to support mental health medication therapy management: Clinical practice considerations and a conceptual framework to enhance patient care

Abstract

Mental illnesses are common and often necessitate the use of medications to improve symptoms. For most common conditions, many pharmacologic treatment options are available, but there is limited evidence to guide the selection of a specific medication or dose for a given patient. Dose‐related side effects are common, and many patients either drop out of treatment or require multiple medication trials before finding a regimen they can tolerate. This prolongs time to remission, increasing suffering and risk for severe outcomes including disability and suicide. A promising approach to reduce early medication discontinuation or switching is through the strategic application of pharmacogenomics (PGx), which utilizes an individual's genetic information to refine dosing or better select an optimal medication. Extensive research has established how genetic variation may influence to what extent individuals metabolize medications commonly prescribed for mental illnesses. The evidence‐based integration of PGx information into clinical care necessitates a patient‐centered approach that considers many factors. Comprehensive medication management by pharmacists provides an optimal framework to incorporate PGx information to improve treatment precision in mental health.This article is protected by copyright. All rights reserved.

Clinical Utility and Implementation of Pharmacogenomics for the Personalisation of Antipsychotic Treatments

“…The influence of functional polymorphisms in metabolic enzymes on the clearance of antipsychotic drugs has been proven in numerous studies [ 2 , 4 , 24 ]. Cytochrome P450 (CYP) functional variants associated with slower (poor metabolisers) or faster (rapid or ultrarapid metabolisers) metabolic rates are known to significantly contribute to antipsychotic efficacy and toxicity [ 2 , 25 , 26 ]. More robust data have been obtained for functional variants in CYP2D6 and CYP2C19 enzymes.…”