Pharmacopsychiatry
DOI: 10.1055/a-1288-1061
Review

Review and Consensus on Pharmacogenomic Testing in Psychiatry

Chad A. Bousman
1  Departments of Medical Genetics, Psychiatry, Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada
2  Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
3  Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
4  Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
,
Susanne A. Bengesser
5  Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
,
Katherine J. Aitchison
6  Departments of Psychiatry, Medical Genetics and the Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
,
Azmeraw T. Amare
7  Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
8  South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
,
Harald Aschauer
9  Biopsychosocial Corporation (BioPsyC), non-profit association, Vienna, Austria
,
Bernhard T. Baune
10  Department of Psychiatry and Psychotherapy, University of Münster, Germany
4  Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
11  The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
,
Bahareh Behroozi Asl
6  Departments of Psychiatry, Medical Genetics and the Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
,
Jeffrey R. Bishop
12  Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
,
Margit Burmeister
13  Michigan Neuroscience Institute and Departments of Computational Medicine & Bioinformatics, Human Genetics and Psychiatry, The University of Michigan, Ann Arbor MI, USA
,
Boris Chaumette
14  Institute of Psychiatry and Neuroscience of Paris, GHU Paris Psychiatrie & Neurosciences, University of Paris, Paris, France
15  Department of Psychiatry, McGill University, Montreal, Canada
,
Li-Shiun Chen
16  Departments of Psychiatry and Genetics, Washington University School of Medicine in St. Louis, USA
,
Zachary A. Cordner
17  Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
,
Jürgen Deckert
18  Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, Würzburg, Germany
,
Franziska Degenhardt
19  Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
20  Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
,
Lynn E. DeLisi
21  Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts, USA
,
Lasse Folkersen
22  Institute of Biological Psychiatry, Capital Region Hospitals, Copenhagen, Denmark
,
James L. Kennedy
23  Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
24  Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
,
Teri E. Klein
25  Department of Biomedical Data Science, Stanford University, Stanford, California, USA
,
Joseph L. McClay
26  Department of Pharmacotherapy and Outcome Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
,
Francis J. McMahon
27  Human Genetics Branch, National Institute of Mental Health, Bethesda, MD, USA
,
Richard Musil
28  Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
,
Nancy L. Saccone
16  Departments of Psychiatry and Genetics, Washington University School of Medicine in St. Louis, USA
,
Katrin Sangkuhl
25  Department of Biomedical Data Science, Stanford University, Stanford, California, USA
,
Robert M. Stowe
29  Departments of Psychiatry and Neurology (Medicine), University of British Columbia, USA
,
Ene-Choo Tan
30  KK Research Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
,
Arun K. Tiwari
23  Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
24  Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
,
Clement C. Zai
23  Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
24  Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
,
Gwyneth Zai
23  Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
24  Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
,
Jianping Zhang
31  Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Westchester Division, White Plains, NY, USA
,
Andrea Gaedigk
32  Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children’s Mercy Kansas City, Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
,
Daniel J Müller
23  Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
24  Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations
Funding: The work was supported in part by an Alberta Innovates Strategic Research Project G2018000868 (Drs. Aitchison and Bousman), the Neuroscience and Mental Health Institute and Department of Psychiatry, University of Alberta (Ms. Behroozi Asi), NARSAD Young Investigator Grant from the Brain & Behaviour Research Foundation (Dr. Amare), the Foundation Bettencourt-Schueller (Dr. Chaumette), the European COST Action EnGagE CA17130 (Dr. Degenhardt), the German Federal Ministry of Education and Research e:Med programme (Dr. Degenhardt), the NIH/NHGRI U24 HG010615 (Drs. Klein and Sangkuhl), the NIH/NIGMS R24 GM123930 (Dr. Gaedigk), the NIDA R01 DA038076 (Dr. Li-Shiun), and the NIMH Intramural Research Program (Dr. McMahon).

Abstract

The implementation of pharmacogenomic (PGx) testing in psychiatry remains modest, in part due to divergent perceptions of the quality and completeness of the evidence base and diverse perspectives on the clinical utility of PGx testing among psychiatrists and other healthcare providers. Recognizing the current lack of consensus within the field, the International Society of Psychiatric Genetics assembled a group of experts to conduct a narrative synthesis of the PGx literature, prescribing guidelines, and product labels related to psychotropic medications as well as the key considerations and limitations related to the use of PGx testing in psychiatry. The group concluded that to inform medication selection and dosing of several commonly-used antidepressant and antipsychotic medications, current published evidence, prescribing guidelines, and product labels support the use of PGx testing for 2 cytochrome P450 genes (CYP2D6, CYP2C19). In addition, the evidence supports testing for human leukocyte antigen genes when using the mood stabilizers carbamazepine (HLA-A and HLA-B), oxcarbazepine (HLA-B), and phenytoin (CYP2C9, HLA-B). For valproate, screening for variants in certain genes (POLG, OTC, CSP1) is recommended when a mitochondrial disorder or a urea cycle disorder is suspected. Although barriers to implementing PGx testing remain to be fully resolved, the current trajectory of discovery and innovation in the field suggests these barriers will be overcome and testing will become an important tool in psychiatry.



Publication History

Received: 09 July 2020
Received: 05 October 2020

Accepted: 07 October 2020

Publication Date:
04 November 2020 (online)

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