Precision psychiatry in clinical practice

Abstract

The treatment of depression represents a major challenge for healthcare systems and choosing among the many available drugs without objective guidance criteria is an error-prone process. Recently, pharmacogenetic biomarkers entered in prescribing guidelines, giving clinicians the possibility to use this additional tool to guide prescription and improve therapeutic outcomes. This marked an important step towards precision psychiatry, which aim is to integrate biological and environmental information to personalise treatments. Only genetic variants in cytochrome enzymes are endorsed by prescribing guidelines, but in the future polygenic predictors of treatment outcomes may be translated into the clinic. The integration of genetics with other relevant information (e.g., concomitant diseases and treatments, drug plasma levels) could be managed in a standardised way through ad hoc software. The overcoming of the current obstacles (e.g., staff training, genotyping and informatics facilities) can lead to a broad implementation of precision psychiatry and represent a revolution for psychiatric care.

Key points

• Precision psychiatry aims to integrate biological and environmental information to personalise treatments and complement clinical judgement

• Pharmacogenetic biomarkers in cytochrome genes were included in prescribing guidelines and represented an important step towards precision psychiatry

• Therapeutic drug monitoring is an important and cost-effective tool which should be integrated with genetic testing and clinical evaluation in order to optimise pharmacotherapy

• Other individual factors relevant to pharmacotherapy response (e.g., individual’s symptom profile, concomitant diseases) can be integrated with genetic information through artificial intelligence to provide treatment recommendations

• The creation of pharmacogenetic services within healthcare systems is a challenging and multi-step process, education of health professionals, promotion by institutions and regulatory bodies, economic and ethical barriers are the main issues

Keywords:

• Antidepressant
• depression
• pharmacogenetics
• genetics
• biomarker
• precision medicine

Disclosure statement

Zanardi R., Fabbri C., Prestifilippo D., and Colombo C. declare no conflict of interest. Eduard Maron is the founder and CEO of Documental Ltd. Serretti A. is or has been consultant/speaker for: Abbott, Abbvie, Angelini, Astra Zeneca, Clinal Data, Boheringer, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lunbeck, Naurex, Pfizer, Polipharma, Sanofi, Servier.