The Importance of Pharmacogenetics in Modern Psychiatric Treatment
Initial research in pharmacogenetics focused on identifying enzyme mutations that accounted for individual differences in drug metabolism. The research then expanded to include genes controlling pharmacodynamic processes. The investigation of polymorphisms, receptors, enzymes, and transporters from the pharmacodynamic side, and of metabolic enzymes - specifically cytochromes P450 (CYP) from the pharmacokinetic side, is currently the only area showing significant potential for application in clinical practice. The most studied pharmacodynamic markers in psychiatric practice include the polymorphisms: ABCB1 transporter (MDR), COMT, DAT, DRD2, and SERT. Among pharmacokinetic markers, the enzymes contributing most to metabolism are CYP3A4 (50%), CYP2D6 (20%), and CYP2C9 and CYP2C19 (15%). Poor metabolizers (PM) are at risk of intoxication with drugs primarily metabolized via CYP2D6. Accordingly, routine genotyping for CYP2D6 is now recommended to avoid intoxications, to identify drug resistance, or to differentiate between non-adherence and ultra-rapid drug metabolizers.
Key words:
cytchrome P450; pharmacodynamics; pharmacogenetics; pharmacokinetics; polymorphism
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