Electronic Letters to:

Special articles:
Richard Hodgson, Susan E. Smith, Richard C. Strange, and Anthony A. Fryer
Service innovations: Pharmacogenetic clinics in psychiatry: a clinical reality?
Psychiatr Bull 2004; 28: 298-300 [Abstract] [Full text] [PDF]
*eLetters: Submit a response to this article

Electronic letters published:

[Read eLetter] pharmacogenetics and ethnicity
sanju george   (9 August 2004)

pharmacogenetics and ethnicity 9 August 2004
Top
sanju george,
specialist registrar in general adult psychiatry
Sandwell Outreach Team, West Midlands, B69 4AL

Send letter to journal:
Re: pharmacogenetics and ethnicity

sanju.george{at}talk21.com sanju george

Hodgson et al (Psychiatric Bulletin, August2004, 28,298-300), highlight the pharmacogenetic considerations in treating patients with psychotropics. It was interesting to note the omission of the ethnic distribution of their patient sample.

This is relevant and would have been informative, given the reasonably well-established differences in distribution of CYP2D6 alleles across various ethnic groups. To list a few examples: CYP2D6*10, an allele associated with reduced enzymatic activity, is found in nearly 70% of East Asians, but not in significant proportions in other ethnic groups; CYP2D6*17, also an allele associated with reduced enzymatic activity, is not found in any one other than those of African ancestry; and CYP2D6 activity has been found to be reduced in Asians as compared to Caucasians as a result of gene mutations in around 30% of Asians (Lin and Poland, 1995). This differential distribution of the variant alleles of CYP2D6 across ethnic groups has clinical relevance and needs careful consideration in planning pharmacotherapy.

There are also well-demonstrated ethnic variations in pharmacokinetics and pharmacodynamics of psychotropics (Gaw, 2001). Hence, as well as ethnicity, other broader cultural factors (like dietary factors and habits, alternative treatment models, health and illness beliefs and expectations of treatment, etc) too need to be considered in using psychotropic medication in treating patients with psychiatric disorders. Especially so, for clinicians practising in a multi-cultural society like Britain, it is important to be aware of the influence of ethnic and other cultural factors on pharmacotherapy (given the ethnic differences in pharmacogenetics, pharmacokinetics and pharmacodynamics), for optimising treatment response and reducing the incidence of side effects.

1.Lin, K.M & Poland, R.E. (1995) Ethnicity, culture and psychopharmacology, in Psychopharmacology. The Fourth Generation of Progress. (eds F.E.Bloom &D.J. Kupfer), pp.1907-1917. New York: Raven.

2.Gaw, A.C. (2001) Cross-cultural Psychopharmacology, in Cross- Cultural Psychiatry. pp. 131-137. Washington: American Psychiatric Publishing, Inc.