Book Review
Psychopharmacology
Pharmacogenetics of Psychotropic Drugs. Bernard Lerer, editor. Cambridge (UK): Cambridge University Press; 2002. US$ 130.00. 446 p.
Reviewer
rating*: Very Good
Review by: Gustavo Turecki MD PhD
Montreal, Quebec
Why do some patients respond to a certain drug, while others with the same condition do not? Similarly, why do some patients develop certain side effects and not others? Genetic variation controls to a great extent how we respond to inter- actions with the environment, and the influence of genes on individual pharmacologic response has long been demonstrated. Further, over the last decades, there have been great advances in our understanding of how our genes and genome are structured and function. It is therefore natural that much interest is directed to a better understanding of these important and clinically relevant questions. It is not surprising that in recent years the number of publications reporting pharmacogenetic studies and the number of journals specializing in this subject have increased exponentially. This book provides a handy, timely, and very good review of the current knowledge about the pharmacogenetics of psychiatric disorders and their treatments; as such, it is both an excellent starting point for beginners and an excellent point of reference for those already working in the field.
Divided into 7 different sections, this book offers useful information varying from description of the basic concepts of genetics and pharmacogenetics to discussion of how pharmacogenetic strategies may be applied to the study of psychiatric disorders. Pharmacogenetics and pharmacogenomics are terms that are often used interchangeably. What is the difference between these terms? The editor’s introductory chapter carefully answers this and other basic questions in a useful, although not exhaustive, review of basic terminology and concepts.
Section 2 focuses on clinical background and research design and presents an interesting discussion of some fundamental methodological and conceptual issues involved in pharmacogenetic studies. Reviewing the methodology of pharmacogenetic studies, the authors offer a critical and historical perspective on psychiatric nosology; they propose that current classification systems be thoroughly revised to provide a pharmacologically based disease classification system. A chapter reviewing statistical approaches in pharmacogenetics is also included. However, what is notably missing from this section is a chapter reviewing and discussing, more than superficially, basic concepts of pharmacology–pharmacokinetics and psycho- pharmacology. Such a chapter would have been a useful tool for readers less familiar with the subject. This absence contrasts with the book’s ubiquitous, sometimes excessive, and occasionally repetitious review of basic genetic concepts. Sections 3 and 4 selectively discuss topics on molecular targets and processes that may be relevant for pharmacogenetic studies of psychiatric disorders and studies of the genetic variation controlling the pharmacokinetics of psychotropic drugs.
Section 5 is the longest part of the book, with chapters reviewing available data on pharmacogenetic studies of specific psychopharmacological treatments for psychiatric disorders. Different chapters review studies on neuroleptic response and side effects, on genetic factors and long-term prophylaxis in bipolar disorder, on pharmacogenetics of anxiolytic drugs, on genetic influences on responsiveness to anticonvulsant drugs, on substance dependence, and on Alzheimer’s disease. There is also a chapter on alternative phenotypes and the pharmaco- genetics of mood and anxiety disorders. However, there is no chapter on the growing number of pharmacogenetic studies in major depression. Although this subject is briefly and indirectly addressed in other chapters, a discussion of these studies, including their limitations and promises, would have been interesting—particularly considering that antidepressants are by far the most widely prescribed psychiatric drugs.
Finally, sections 6 and 7 include an interesting chapter on the potential use of brain-imaging techniques in pharmacogenetic studies, together with some discussion on the use of pharmacogenetic strategies in the industry.
Although most of the discussion could have been slightly more critical and attentive to the lessons learned from past experience in psychiatric genetics, particularly to avoid false expectations, this book in general offers a very good review of current data and of pharmacogenetic strategies applied to psychiatric disorders. It brings good value for the price.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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