Psychiatric Pharmacogenomics in the United States: Effects and Affects

Kristi M. Ninnemann, Case Western Reserve University

“It is well known in psychiatry that not all individuals respond the same way to psychiatric medications. What remains less understood is why individuals respond so divergently. Despite the ubiquity of evidence-based pharmacological treatments, the practice of psychopharmacotherapy is empirically based, and optimization of individual patient drug therapy is grounded in a trial-and-error paradigm characterized by multiple clinical attempts to find the “right” drug. This approach has weak outcomes, as evidenced by estimates that 30%-50% of individuals prescribed psychopharmaceutical agents experience suboptimal response. Psychiatric genomics and pharmacogenomic techniques are being heralded as the means by which this heterogeneity of psychiatric drug response can be dissected and corrected.

Pharmacogenomics investigates the ways in which inherited genetic variability impacts psychotropic metabolism and neurotransmitter receptor sensitivity. As genetic differences between individuals are believed by psychiatry to account for up to 90% of the variation observed in psychopharmaceutical efficacy and toxicity, pharmacogenomic testing – as currently conceived – promises psychiatrists a way to improve psychotropic effectiveness through the ability to prescribe the “right” drug to the “right” patient at the “right”  time.

Although pharmacogenomics may be perceived within psychiatry as the solution to observed variance in the efficacy of psychopharmaceuticals, psychological anthropology is well poised to question the cogency of such claims. With the Lemelson Fellowship, I was able to conduct exploratory research investigating the ways in which practitioners conceptualize and experience psychiatric genomics’ benefits and challenges in actual practice. Due to a lacuna of research in this area, it was critical that I conduct this feasibility study before moving forward with a larger dissertation project.  Only through an investigation of the ways in which psychiatric genomic techniques and testing are constructed, implemented, and presented in actual clinical practice was I able to question the extent to which pharmacogenomics currently impacts the practice of psychiatry in the United States.”