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Depression, Anxiety, Stress, and Spirituality in Cardiovascular Disease
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
Erminia Guarneri, Shyamia Stone
Other pharmaceutical agents may also be employed; for example, bupropion may be an effective alternative in patients who are sensitive to side effects of SSRIs or who are attempting smoking cessation.58 However, tricyclic antidepressants have been associated with adverse cardiac events and should be avoided in patients with CVD.58 For individual’s needing medication, we strongly recommend pharmacogenetic testing. Sequencing a patient’s DNA helps to select safe and effective pharmacological treatment avoiding both undesirable side effects and need for multi-drug therapies.80
Pharmacogenetics of opioid addiction: Are they relevant to young people?
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Fleur Davey, Alexander Baldacchino
Advances in pharmacogenetics are starting to be used in healthcare settings to identify individuals who may experience adverse drug reactions to their treatment. The clinical use of pharmacogenetics is not currently routine but is emerging in some specialist fields, such as cancer and cardiovascular medicine (Prows and Prows, 2004; Kudzma and Carey, 2009; Hall-Flavin et al., 2010; Kitzmiller et al., 2011). However, other areas of medicine are now also starting to take advantage of this technology (Kitzmiller et al., 2011; Turner, 2013).
Toxicogenomics
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
Anirudh J. Chintalapati, Zacharoula Konsoula, Barile Frank A.
Response variation has appeared during clinical trials of new drugs. For example, the anticancer drug trastuzumab (Herceptin) has been found to be effective only in women who carry multiple copies of the ERBB2 gene (also known as HER2/neu). Therefore, pharmacogenetics allows the early determination of an assortment of potential responses to a new drug and genetic factors that can escalate the risk of detrimental effects and ameliorate patient outcome.
Genetic markers of drug hypersensitivity in pediatrics: current state and promise
Published in Expert Review of Clinical Pharmacology, 2022
Abdelbaset A. Elzagallaai, Michael J. Rieder
Pharmacogenetic testing to optimize drug therapy in general and particularly in children is still in its infancy and pediatricians still typically rely on traditional protocols to manage DHRs. Despite the fact that genetic typing has become more accessible and affordable, its clinical application has not been adopted widely. One reason for that is the lack of standardized reporting systems and terminology as well as lack of training for clinicians and confidence to properly use pharmacogenetic markers in clinical decisions [165,166]. The American Academy of Child and Adolescent Psychiatry has recently issued a statement against the use of pharmacogenetic testing to guide prescribing psychiatric medications for children and adolescents based on a similar communication warning by the FDA that pharmacogenomic testing may lead to ‘inappropriate treatment decisions and potentially serious health consequences for the patient’ [167].
A clinical approach to treatment resistance in depressed patients: What to do when the usual treatments don’t work well enough?
Published in The World Journal of Biological Psychiatry, 2021
Seetal Dodd, Michael Bauer, Andre F. Carvalho, Harris Eyre, Maurizio Fava, Siegfried Kasper, Sidney H. Kennedy, Jon-Paul Khoo, Carlos Lopez Jaramillo, Gin S. Malhi, Roger S. McIntyre, Philip B. Mitchell, Angela Marianne Paredes Castro, Aswin Ratheesh, Emanuel Severus, Trisha Suppes, Madhukar H. Trivedi, Michael E. Thase, Lakshmi N. Yatham, Allan H. Young, Michael Berk
Nevertheless, for a clinician treating depression with antidepressant therapy of adequate dose and duration, failure to respond or partial response is a common clinical challenge that requires a solution. Pharmacotherapeutic strategies are commonly proposed, including augmentation (Edwards et al. 2013; Carvalho et al. 2014) or combination therapy (Thomas et al. 2015), as well as other treatments including neurostimulation (including transcranial magnetic stimulation (Emond et al. 2013) and electroconvulsive therapy), psychological treatment (including cognitive behaviour therapy (Carvalho et al. 2014)), and pharmacogenetic guidance (Bousman et al. 2019). Biological explanations of non-response, such as metaboliser status (Parker 2016), are postulated and might adequately explain a proportion of TRD cases. Similarly, TRD is a dilemma for researchers where it is often an exclusion criterion for clinical studies and also because of the controversy surrounding its definition and even the existence of TRD is an unavoidable problem for researchers investigating treatment non-responsive depression.
Precision psychiatry in clinical practice
Published in International Journal of Psychiatry in Clinical Practice, 2021
Raffaella Zanardi, Dario Prestifilippo, Chiara Fabbri, Cristina Colombo, Eduard Maron, Alessandro Serretti
Only a few of the available tests have all the three characteristics reported above and they showed a significant improvement in remission probability in RTCs, with a relative risk of remission compared to standard care of 1.7 according to a recent meta-analysis (Bousman et al. 2019). However, the lack of validation of the prediction algorithms by independent investigators and lack of convincing evidence of cost-effectiveness remain known issues (Linde et al. 2015). Cost-effectiveness of pharmacogenetic testing in psychiatry has not been proven in general, representing the main reason why it is not implemented in routine clinical practice in most countries. Ongoing research is trying to find a definitive answer, as well as identifying the group(s) of patients who are expected to benefit more from testing. The available evidence suggests that patients who did not respond or tolerate at least one previous treatment may benefit more from pharmacogenetic testing (Greden et al. 2019). This concept is also mentioned in guidelines, for example CPIC guidelines (Hicks et al. 2015) state that ‘patients on a stable and effective dose of an SSRI most likely will not benefit from additional dose modifications based on CYP2D6 or CYP2C19 genotype results’.