The Present and Future of Precision Medicine in Psychiatry: Focus on Clinical Psychopharmacology of Antidepressants
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Precision medicine is a concept which is recently gaining momentum in all branches of medicine. In particular in psychiatry it is greatly needed given the huge societal costs of psychiatric disorders and given the long time needed to observe benefit from treatments and the response variability. The future will be based on biological determinants, however until such an interesting but still futuristic aim will be reached, at present we may only rely on clinical features to guide our individualized prescription which is currently still frequently based on personal opinion and subjective previous experiences. The aim of this review is to offer an overview of the main aspects to take into consideration when prescribing an antidepressant treatment to reach the best precision medicine using clinical information. More than 40 compounds are available for treating depression and a similar amount of compounds for other psychiatric disorders. The process of matching the profile of the patient with all different profiles of available compounds is therefore quite complex. Our everyday prescribing procedure should take into consideration a number of factors such as the knowledge of the profile of available compounds versus the symptomatology profile of the subject, previous efficacy, medical comorbidities, tolerability profile, individual preferences, and family history. While we are waiting more complex algorithms including biological or genetic measures, it is possible to optimize our current prescription practice by using all available information in order to obtain as much as possible an evidence based precision medicine prescription.
Abstract
Precision medicine is a concept which is recently gaining momentum in all branches of medicine. In particular in psychiatry it is greatly needed given the huge societal costs of psychiatric disorders and given the long time needed to observe benefit from treatments and the response variability. The future will be based on biological determinants, however until such an interesting but still futuristic aim will be reached, at present we may only rely on clinical features to guide our individualized prescription which is currently still frequently based on personal opinion and subjective previous experiences. The aim of this review is to offer an overview of the main aspects to take into consideration when prescribing an antidepressant treatment to reach the best precision medicine using clinical information. More than 40 compounds are available for treating depression and a similar amount of compounds for other psychiatric disorders. The process of matching the profile of the patient with all different profiles of available compounds is therefore quite complex. Our everyday prescribing procedure should take into consideration a number of factors such as the knowledge of the profile of available compounds versus the symptomatology profile of the subject, previous efficacy, medical comorbidities, tolerability profile, individual preferences, and family history. While we are waiting more complex algorithms including biological or genetic measures, it is possible to optimize our current prescription practice by using all available information in order to obtain as much as possible an evidence based precision medicine prescription.
참고문헌 (17)
- Serretti A, "Antidepressants and body weight: a comprehensive review and meta-analysis", J Clin Psychiatry, 71, pp.1259~1272 (2010)[DOI]
- Alberti S, "Insomnia and somnolence associated with second-generation antidepressants during the treatment of major depression: a metaanalysis", J Clin Psychopharmacol, 35, pp.296~303 (2015)[DOI]
- Delavenne X, "Investigation of drug-drug interactions between clopidogrel and fluoxetine", Fundam Clin Pharmacol, 27, pp.683~689 (2013)[DOI]
- Fabbri C, "Progress and prospects in pharmacogenetics of antidepressant drugs", Expert Opin Drug Metab Toxicol, 12, pp.1157~1168 (2016)[DOI]
- Perlis RH, "Abandoning personalization to get to precision in the pharmacotherapy of depression", World Psychiatry, 15, pp.228~235 (2016)[DOI]
- Sankar PL, "The Precision Medicine Initiative's All of Us Research Program: an agenda for research on its ethical, legal, and social issues", Genet Med, 19, pp.743~750 (2017)[DOI]
- Kennedy SH, "Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 3. Pharmacological treatments", Can J Psychiatry, 61, pp.540~560 (2016)[DOI]
- Cipriani A, "Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis", Lancet, 373, pp.746~758 (2009)[DOI]
- Franchini L, "Familial concordance of fluvoxamine response as a tool for differentiating mood disorder pedigrees", J Psychiatr Res, 32, pp.255~259 (1998)[DOI]
- Porcelli S, "Genetic polymorphisms of cytochrome P450 enzymes and antidepressant metabolism", Expert Opin Drug Metab Toxicol, 7, pp.1101~1115 (2011)[DOI]
- Stahl SM, "Stahl's essential psychopharmacology: neuroscientific basis and practical application" (2013), Cambridge University Press
- Serretti A, "Antidepressants in healthy subjects: what are the psychotropic", psychological effects?, 2010, pp.20, 433~453
- Harmer CJ, "How do antidepressants work? New perspectives for refining future treatment approaches", Lancet Psychiatry, 4, pp.409~418 (2017)[DOI]
- Taylor D, "The Maudsley prescribing guidelines in psychiatry. 12th ed." (2015), John Wiley & Sons
- Serretti A, "Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis", J Clin Psychopharmacol, 29, pp.259~266 (2009)[DOI]
- Sang Won Jeon, "Measurement-based Treatment of Residual Symptoms Using Clinically Useful Depression Outcome Scale: Korean Validation Study", Clinical Psychopharmacology and Neuroscience, 15(1), pp.28~34 (2017), 대한정신약물학회[DOI]
- 오강섭, "Early Improvement in One Week Predicts the Treatment Response to Escitalopram in Patients with Social Anxiety Disorder: A Preliminary Study", Clinical Psychopharmacology and Neuroscience, 14(2), pp.161~167 (2016), 대한정신약물학회