Utilizing Pharmacogenetics in Psychiatry: the Time Has Come
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COMMENTARY
Utilizing Pharmacogenetics in Psychiatry: the Time Has Come David Durham
Ó Springer International Publishing Switzerland 2014
Psychiatry remains the most subjective field in medicine. This has probably been the greatest barrier to improving the accuracy of diagnosis, quantifiably reducing adverse drug events, and substantially improving treatment outcomes. The utilization of pharmacogenetic technology in psychiatry is the first clinical modality of its kind to increase both the accuracy and the precision of prescribing psychotropic medications while simultaneously reducing adverse drug events and deaths. The Centers for Medicaid and Medicare Services CMS) estimate that adverse drug events (ADEs) in the USA cost about US$289 billion [1], a figure that does not consider data from numerous private insurance companies [2]. Over 770,000 people are injured or die each year in hospitals from ADEs. Adverse drug reactions are estimated to be responsible for an estimated 100,000 deaths every year and range from the fourth to the sixth leading cause of death in the USA [2, 3]. Studies of geriatric outpatients have found that the percentage of potential clinically significant adverse drug reactions ranges from 6 to 25 % [4]. An estimated 17 % of the top 200 prescribed drugs in 2012 have a US Food and Drug Administration (FDA) pharmacogenetic warning in the package insert. These numbers grow larger each year. There is good information, dating back more than a decade, that psychiatric medications have, for some time, been among the most common medications found in deaths caused by the adverse effects of prescription drugs. A report [5] published in 2005 by Drs. Paulozzi and Annest at the Centers for Disease Control (CDC), titled ‘Unintentional Poisoning Death: United D. Durham (&) The University of New Mexico, School of Medicine, Albuquerque, NM, USA e-mail: [email protected]
States 1999–2004’, found that opioids were, by far, the most common medication associated with death caused by prescribed drugs during this period—at 75.2 %. The authors found that the second most common prescribed medication was benzodiazepines—at 29.4 %—and the third was antidepressants—at 17.6 %. The CDC’s on-line ‘Drug Overdose in the United States: Fact Sheet’ reports that in 2010, of the 38,329 drug overdose deaths in the USA, 22,134 (60 %) were related to prescription drug overdoses, and 6,497 (30 %) involved benzodiazepines. In the same CDC report, the authors note that in 2011, approximately 501,207 emergency department visits were related to anti-anxiety and insomnia medications [6, 7]. It is noteworthy to mention that all of the medications in the benzodiazepine family, and most of the medications in the sedative–hypnotic family, are principally metabolized by the cytochrome P450 (CYP) enzyme system. In October 2013, an article published in JAMA Psychiatry addressed the mounting concern that the increased mortality risk among patients with psychiatric illness may be worsened by psychopharmacological agents. The authors analyze
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