Pharmacogenetics: optimizing the efficacy of psychiatric drugs

In the field of psychiatry, pharmacological treatment is a fundamental part of addressing mental disorders such as depression, schizophrenia and bipolar disorder. However, patients' response to psychiatric medications can vary considerably. This is where pharmacogenetics comes into play, allowing for more accurate drug selection and improved therapeutic response. In this article, we will explore how pharmacogenetics is optimizing the efficacy of psychiatric medications.

Identifying genetic biomarkers: Pharmacogenetics analyzes genetic variants that may influence how an individual processes psychiatric medications. By identifying specific genetic biomarkers, it is possible to predict how a patient will respond to a particular drug. For example, certain genetic variants have been found to be associated with a lower response to antidepressants or a higher risk of side effects.

Personalized drug selection: Thanks to pharmacogenetics, physicians can use genetic testing to make more informed decisions about which psychiatric medications are best suited for a particular patient. For example, in the treatment of depression, genetic variants that influence response to traditional antidepressants or newer medications such as selective serotonin reuptake inhibitors (SSRIs) or norepinephrine and serotonin reuptake inhibitors (SNRIs) can be evaluated.

Dose personalization and therapeutic titration: In addition to drug selection, pharmacogenetics can also help determine the optimal dose for a particular patient. Some genetic variants can influence how the body metabolizes and eliminates a drug, which can affect blood concentration and treatment efficacy. By considering these genetic factors, physicians can adjust doses of psychiatric medications to maximize efficacy and minimize side effects.

Reducing treatment errors: Pharmacogenetics not only helps optimize the efficacy of psychiatric medications, but can also reduce the need for lengthy trials and treatment errors. By using genetic testing to guide medication selection, clinicians can avoid ineffective and potentially harmful treatments, saving time and improving patients' quality of life.

Interindividual differences in antidepressant drug exposure are attributed to genetic variations that alter metabolic capacity or to interactions between drugs that inhibit or induce CYP2D6 or CYP2C19 activity. More than ten drugs approved for the treatment of depression have pharmacogenetic information related to CYP2D6 or CYP2C19 in the label that addresses drug exposure.

For instance, it has recently been described that elevated CYP2D6-CYP2C19 metabolic capacity may be associated with multiple suicide reattempts due to drug treatment failure in patients taking drugs that are substrates of these enzymes.

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