Pharmacogenomics to support mental health medication therapy management: Clinical practice considerations and a conceptual framework to enhance patient care

Mental illnesses are common and often necessitate the use of medications to improve symptoms. For most common conditions, many pharmacologic treatment options are available, but there is limited evidence to guide the selection of a specific medication or dose for a given patient. Dose-related side effects are common, and many patients either drop out of treatment or require multiple medication trials before finding a regimen they can tolerate. This prolongs time to remission, increasing suffering and risk for severe outcomes including disability and suicide. A promising approach to reduce early medication discontinuation or switching is through the strategic application of pharmacogenomics (PGx), which utilizes an individual's genetic information to refine dosing or better select an optimal medication. Extensive research has established how genetic variation may influence to what extent individuals metabolize medications commonly prescribed for mental illnesses. The evidence-based integration of PGx information into clinical care necessitates a patient-centered approach that considers many factors. Comprehensive medication management by pharmacists provides an optimal framework to incorporate PGx information to improve treatment precision in mental health.