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Pharmacogenomics: an Update for Child and Adolescent Psychiatry

  • Child and Adolescent Disorders (TD Benton, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This paper aims to acquaint child and adolescent psychiatrists with the field of pharmacogenomics (PGX) and review the most up-to-date evidence-based practices to guide the application of this field in clinical care.

Recent Findings

Despite much research being done in this area, the field of PGX continues to yield controversial findings. In the adult world, studies have focused on the impact of combinatorial gene panels that guide medication selection by providing reports that estimate the impact of multiple pharmacodynamic and pharmacokinetic genes, but to date, these have not been directly examined in younger patient populations. Pharmacokinetic genes, CYP2D6 and CYP2C19, and hypersensitivity genes, HLA-A and HLA-B, have the strongest evidence base for application to pharmacotherapy in children.

Summary

Although the field is evolving, and the evidence is mixed, there may be a role for PGX testing in children to help guide dosing and monitoring strategies. However, evidence-based medicine, rather than PGX testing, continues to play the lead role in guiding medication selection in pediatric psychopharmacology.

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Abbreviations

5-HTT:

Serotonin Transporter

CGI:

Clinical Global Impressions Scale

COMT:

Catecholamine-O-methyltransferase

CPIC:

Clinical Pharmacogenetics Implementation Consortium

CYP:

Cytochrome P450

DPWG:

Dutch Pharmacogenetics Working Group

GENDEP:

Genome-Based Therapeutic Drugs for Depression

GWAS:

Genome Wide Association Study

HAM-D:

Hamilton Depression Rating Scale

HLA:

Human Leukocyte Antigen

HTR2A:

Serotonin receptor 2A

ISPG:

International Society for Psychiatric Genetics

MARS:

Munich Antidepressant Response Signature

PD:

Pharmacodynamic(s)

PGI-I:

Patient Global Impression of Improvement Scale

PGX:

Pharmacogenomic(s)

PK:

Pharmacokinetic(s)

SERT:

Another name for the Serotonin Transporter

SNP:

Single Nucleotide Polymorphism

STAR*D:

Sequenced Treatment Alternatives to Relieve Depression

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Funding

Gualberto Ruaño reports support from Genomas Inc., outside the submitted work. In addition, Dr. Ruano has Patent No. US 9,558,320 B2 Physiogenomic Method for Predicting Drug Metabolism Reserve for Antidepressants and Stimulants issued.

Author information

Authors and Affiliations

  1. Associate Professor of Pediatrics and Psychiatry, University of Connecticut School of Medicine, Division of Child and Adolescent Psychiatry, Institute of Living/Hartford Hospital, 200 Retreat Ave, Hartford, CT, 06019, USA

    Lisa B. Namerow

  2. Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06032, USA

    Sophia A. Walker

  3. Division of Child and Adolescent Psychiatry, Institute of Living/Hartford Hospital, 200 Retreat Ave, Hartford, CT, 06019, USA

    Mirela Loftus

  4. Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Department of Psychiatry, University of Minnesota Medical School, 508 Harvard St SE, Minneapolis, MN, 55455, USA

    Jeffrey R. Bishop

  5. Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06032, USA

    Gualberto Ruaño

  6. Institute of Living at Hartford Hospital, Genomas Laboratory of Personalized Health, 67 Jefferson Street, Hartford, CT, 06106, USA

    Gualberto Ruaño

  7. Division of Child and Adolescent Psychiatry, Institute of Living/Hartford Hospital, 200 Retreat Ave, Hartford, CT, 06019, USA

    Salma Malik

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  1. Lisa B. Namerow
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Correspondence to Lisa B. Namerow.

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Conflict of Interest

Sophia A. Walker, Mirela Loftus, and Salma Malik each declare no potential conflicts of interest.

Lisa B. Namerow received a grant from Hartford Hospital to support a research coordinator for her research project conducted and cited in this paper.

Jeffrey R. Bishop is a member of the Clinical Pharmacogenetics Implementation Consortium and is a consultant to OptumRx.

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Namerow, L.B., Walker, S.A., Loftus, M. et al. Pharmacogenomics: an Update for Child and Adolescent Psychiatry. Curr Psychiatry Rep 22, 26 (2020). https://doi.org/10.1007/s11920-020-01145-4

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  • DOI: https://doi.org/10.1007/s11920-020-01145-4

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