Psychopharmacologic considerations in the treatment of black American populations

Although striking ethnic differences in pharmacologic responses to various medications have been documented in the general medical literature, there is a paucity of such information in the psychopharmacologic literature. Recent work has provided a number of studies that illustrate interesting inter-ethnic pharmacogenetic, pharmacokinetic, and pharmacodynamic differences. In general, however, such studies have reported inconsistent findings relative to dose response relationships with various psychotropics. Results of our literature review, with a particular focus on black Americans, suggest that the lack of consistency in these investigations is largely attributable to various methodological and design problems. Prominent among these problems are: diagnostic misclassification, treatment of various ethnic groups in a homogeneous undifferentiated manner, lack of appropriate control for age and gender, and minimal consideration for chronicity of illness. As a result, though there exist some interesting data suggesting inter-ethnic genetic and kinetic differences, the extant literature on black Americans and other ethnic groups should be evaluated with some caution. The purpose of this article is to provide a systematic review of the existing psychopharmacologic literature on the black American population.