Pharmacogenomics in psychiatry: Practice recommendations from an Asian perspective (2024)

Area of Science:

• Psychiatric pharmacogenomics
• Genetics in mental health treatment
• Personalized medicine in psychiatry

Background:

• Pharmacogenomic testing is emerging in psychiatry for medication guidance.
• Direct-to-consumer panels face adoption barriers: variable evidence, cost-effectiveness, and regulatory hurdles.
• Recommendations are needed for Asian populations.

Purpose of the Study:

• To review recent updates in psychiatric pharmacogenomics.
• To provide a contextualized summary and recommendations for Asian populations.
• To guide healthcare professionals in psychiatric practice.

Main Methods:

• Literature review of pharmacogenomics in psychiatry, focusing on Asian populations.
• Application of the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework.
• Consensus meetings with psychiatrists from public and private sectors.

Main Results:

• Pharmacogenomic testing should focus on drug-gene pairs with established evidence (e.g., antidepressants and CYP2C19/CYP2D6).
• Direct-to-consumer panels are not recommended in Singapore due to inconclusive clinical outcome data.
• Current evidence does not support routine pharmacogenomic testing in psychiatric practice.

Conclusions:

• Pharmacogenomic testing is not recommended as standard psychiatric practice.
• Exceptions include concerns about drug concentrations or severe adverse drug reactions.
• Further research on drug-gene associations, clinical, and cost-effectiveness is encouraged.