Future roles of pharmacogenomic testing and biomarkers in psychiatry.

Abstract

Since the discovery of the antipsychotic action of chlorpromazine in 1952 (Delay et al., 1956), and of the antidepressant effect of imipramine in 1956 (Kuhn, 1957), the psychopharmacological portfolio has developed and differentiated substantially. Research has provided many insights into how molecular agents infl uence the dopamine, serotonin, noradrenalin, acetylcholine, and γ -aminobutyric acid neurotransmitter systems including their receptors, receptor subtypes, reuptake pumps and metabolizing enzymes. This has led to the development of several widely used medications. Additionally, medications have been developed to modulate the activity of neuronal ion channels providing further success in the exciting fi eld of neuropsychopharmacology. The fi eld will probably soon see the introduction of drugs infl uencing hormonal systems, cytokines, endogenous cannabinoids and eicosanoids as well as their second and third messengers. This undoubtedly will bring benefi ts to many more patients. However, despite those growing numbers of treatment options, substantial gaps in care remain due to limited of knowledge of how to match individual patients with individually appropriate drugs. As a result, only a small proportion of patients who receive ‘ adequate treatment ’ achieve full remission with the fi rst applied psychopharmacological drug (Himmerich