Successes and Challenges in Precision Medicine in Psychiatry

Currently, considerable effort is devoted to finding novel drug targets. Problematically, the development of new medications is extremely expensive and takes many years. A parallel and potentially more immediate route to enhance treatment efficacy and minimize common adverse effects is to tailor the use of existing drugs to individual patients. However, the field of precision medicine has struggled to develop accurate approaches for predicting psychotropic drug response. Initial efforts involved pharmacogenetic studies of candidate genes thought to be relevant to the pharmacokinetics and pharmacodynamics of the drug. These studies were hampered by the fact that deep mechanistic knowledge of drug action is typically lacking. With advances in genomic technologies, it has become possible to bypass the need for such knowledge by studying genetic variation on a genome-wide scale. This has yielded multiple encouraging findings. For example, genome-wide association and/or whole-exome sequencing studies have implicated the human leukocyte antigen locus in clozapine-induced agranulocytosis, the melanocortin 4 receptor (MC4R) gene in antipsychotic-induced weight gain, and the contactin associated protein like 5 (CNTNAP5) gene in symptom reduction associated with the use of antipsychotic medications.

Source: JAMA Psychiatry - November 7, 2018 Category: Psychiatry Source Type: research