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  • Print publication year: 2008
  • Online publication date: August 2009

3 - Culture and ethnicity in psychopharmacotherapy



The use of psychiatric medication has transcended geographic, cultural, and ethnic boundaries during the past several decades (Lin, Poland et al., 1993; Lin & Cheung, 1999; Lin & Smith, 2000). Within a few years of their discovery, modern psychotropics have achieved worldwide acceptance as the mainstay for the treatment of the mentally ill (Lin, Poland et al., 1993; Ng, Lin et al., 2005). This notwithstanding, until most recently, clinicians and researchers have paid little attention to potential influences of ethnic and cultural factors on pharmacotherapeutic responses. With a few prominent exceptions, practically all psychiatric medications have been developed and tested in North America and Western Europe, and often, on “young, white males.” In addition, since these research efforts usually aim at defining what are “typical” that can be generalized, variations in responses are often regarded as “noises” and consequently ignored. Therefore, although substantial differences in psychotropic responses have been repeatedly observed and documented in the literature, such information has not been widely disseminated, and our knowledge in this regard is still sparse and unsystematic. Treatment decisions are generally not individualized; choice of medication and dosing routines are largely based on “trial and error” practices rather than on rational principles.

In contrast, recent literature clearly demonstrates that ethnicity and culture powerfully determine individuals' pharmacological responses (Lin & Poland, 1995). These responses are shaped simultaneously by genetic and environmental factors.

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Aklillu, E., Persson, al. (1996). Frequent distribution of ultrarapid metabolizers of debrisoquine in an Ethiopian population carrying duplicated and multiduplicated functional CYP2D6 alleles.J. Pharmacol. Exp. Ther., 278(1), 441–6.
Allen, J. J., P. H., Rack,et al. (1977). Differences in the effects of clomipramine on English and Asian volunteers. Preliminary report on a pilot study.Postgrad. Med. J., 53 (4), 79–86.
Anderson, K. E. & A., Kappas (1991). Dietary regulation of cytochrome P450.Annu. Rev. Nutr., 11, 141–67.
Arias, B.. et al. (2003). 5-HTTLPR polymorphism of the serotonin transporter gene predicts non-remission in major depression patients treated with citalopram in a 12-weeks follow up study.J. Clin. Psychopharmacol., 23(6), 563–7.
Beratis, S., , Katrivanou, al. (2001). Factors affecting smoking in schizophrenia.Compr. Psychiatry, 42(5), 393–402.
Branch, R. A., , Salih, S. al. (1978). Racial differences in drug metabolizing ability: a study with antipyrine in the Sudan.Clin. Pharmacol. Ther., 24(3), 283–6.
Choi, J. Y., , Lee, K. al. (2003). CYP2E1 and NQO1 genotypes, smoking and bladder cancer.Pharmacogenetics, 13(6), 349–55.
Dahl, M. L., , Yue, Q. al. (1995). Genetic analysis of the CYP2D locus in relation to debrisoquine hydroxylation capacity in Korean, Japanese and Chinese subjects.Pharmacogenetics, 5(3), 159–64.
Daly, A. K., , Brockmoller, al. (1996). Nomenclature for human CYP2D6 alleles.Pharmacogenetics, 6(3), 193–201.
Morais, S. M., , Wilkinson, G. al. (1994). The major genetic defect responsible for the polymorphism of S-mephenytoin metabolism in humans.J. Biol. Chem., 269(22), 15419–22.
Fraser, H. S., , Mucklow, J. al. (1979). Environmental factors affecting antipyrine metabolism in London factory and office workers.Br. J. Clin. Pharmacol., 7(3), 237–43.
Fuhr, U., , Klittich, al. (1993). Inhibitory effect of grapefruit juice and its bitter principal, naringenin, on CYP1A2 dependent metabolism of caffeine in man.Br. J. Clin. Pharmacol., 35(4), 431–6.
Gelernter, J., , Kranzler, al. (1997). Serotonin transporter protein (SLC6A4) allele and haplotype frequencies and linkage disequilibria in African- and European-American and Japanese populations and in alcohol-dependent subjects.Hum. Genet., 101(2), 243–6.
Goldstein, J. A., , Ishizaki, al. (1997). Frequencies of the defective CYP2C19 alleles responsible for the mephenytoin poor metabolizer phenotype in various Oriental, Caucasian, Saudi Arabian and American black populations.Pharmacogenetics, 7(1), 59–64.
Greenberg, B. D., , McMahon, F. al. (1998). Serotonin transporter candidate gene studies in affective disorders and personality: promises and potential pitfalls.Mol. Psychiatry, 3(3), 186–9.
Hariri, A. R. & , Weinberger, D. R. (2003). Functional neuroimaging of genetic variation in serotonergic neurotransmission.Genes Brain Behav., 2(6), 341–9.
Jurima-Romet, M., , Crawford, al. (1994). Terfenadine metabolism in human liver. In vitro inhibition by macrolide antibiotics and azole antifungals.Drug Metab. Dispos., 22(6), 849–57.
Kelly, C. & , McCreadie, R. G. (1999). Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland.Am. J. Psychiatry, 156(11), 1751–7.
Kim, H., , Lim, S. al. (2006). Monoamine transporter gene polymorphisms and antidepressant response in Koreans with late-life depression.JAMA, 296(13), 1609–18.
Marchand, L., , Sivaraman, al. (1998). Associations of CYP1A1, GSTM1, and CYP2E1 polymorphisms with lung cancer suggest cell type specificities to tobacco carcinogens.Cancer Res., 58(21), 4858–63.
Leathart, J. B., , London, S. J., et al. (1998). CYP2D6 phenotype-genotype relationships in African-Americans and Caucasians in Los Angeles.Pharmacogenetics, 8(6), 529–41.
Lin, K., , Elwyn, T. S., et al. (2004). Culture and Drug Therapy in Clinician's Guide to Cultural Psychiatry. Amsterdam: Elsevier.
Lin, K. M. & , Cheung, F. (1999). Mental health issues for Asian Americans.Psychiatr. Serv., 50(6), 774–80.
Lin, K. M. & , Poland, R. E. (1995). Ethnicity, Culture, and Psychopharmacology in Psychopharmacology: The Fourth Generation of Progress. New York; NY: Raven Press.
Lin, K. M., , Poland, R. al. (1988). Haloperidol and prolactin concentrations in Asians and Caucasians.J. Clin. Psychopharmacol., 8(3), 195–201.
Lin, K. M., , Poland, R. al. (1989). A longitudinal assessment of haloperidol doses and serum concentrations in Asian and Caucasian schizophrenic patients.Am. J. Psychiatry, 146(10), 1307–11.
Lin, K. M., , Poland, R. al. (1993). Psychopharmacology and Psychobiology of Ethnicity. Washington, DC: American Psychiatric Press.
Lin, K. M. & , Smith, M. W. (2000). Psychopharmacotherapy in the Context of Culture and Ethnicity. Ethnicity and Psychopharmacology. Washington, DC:American Psychiatric Association.
Lin, K. M., , Smith, M. al. (2003). Psychopharmacology: Ethnic and Cultural Perspectives. Psychiatry. Chichester: John Wiley & Sons.
Liou, Y. H., , Lin, C. al. (2006). The high prevalence of the poor and ultrarapid metabolite alleles of CYP2D6, CYP2C9, CYP2C19, CYP3A4, and CYP3A5 in Taiwanese population.J. Hum. Genet., 51(10), 857–63.
Lohr, J. B. & , Flynn, K. (1992). Smoking and schizophrenia.Schizophr. Res., 8(2), 93–102.
Masimirembwa, C. M. & , Hasler, J. A. (1997). Genetic polymorphism of drug metabolising enzymes in African populations: implications for the use of neuroleptics and antidepressants.Brain. Res. Bull., 44(5), 561–71.
Mendoza, R., , Wan, Y. al. (2001). CYP2D6 polymorphism in a Mexican American population.Clin. Pharmacol. Ther., 70(6), 552–60.
Miller, L. G. (1989). Recent developments in the study of the effects of cigarette smoking on clinical pharmacokinetics and clinical pharmacodynamics.Clin. Pharmacokinet., 17(2), 90–108.
Ng, J., Lin, K. al. (2005). Perspectives in Cross-Cultural Psychiatry. Philadelphia, PA: Lippincott Williams & Wilkins.
Oesterheld, J. & , Kallepalli, B. R. (1997). Grapefruit juice and clomipramine: shifting metabolitic ratios.J. Clin. Psychopharmacol., 17(1), 62–3.
Pollock, B. G., , Ferrell, R. al. (2000). Allelic variation in the serotonin transporter promoter affects onset of paroxetine treatment response in late-life depression.Neuropsychopharmacology, 23(5), 587–90.
Rausch, J. L., , Johnson, M. al. (2002). Initial conditions of serotonin transporter kinetics and genotype: influence on SSRI treatment trial outcome.Biol. Psychiatry, 51(9), 723–32.
Roby, C. A., , Anderson, G. al. (2000). St John's Wort: effect on CYP3A4 activity.Clin. Pharmacol. Ther., 67(5), 451–7.
Roh, H. K., , Dahl, M. al. (1996). Debrisoquine and S-mephenytoin hydroxylation phenotypes and genotypes in a Korean population.Pharmacogenetics, 6(5), 441–7.
Schein, J. R. (1995). Cigarette smoking and clinically significant drug interactions.Ann. Pharmacother., 29(11), 1139–48.
Schildkraut, J. J., , Kopin, I. al. (1995). Norepinephrine metabolism and psychoactive drugs in the endogenous depressions. 1968.Pharmacopsychiatry, 28 (1): 24–37.
Smeraldi, E., , Zanardi, al. (1998). Polymorphism within the promoter of the serotonin transporter gene and antidepressant efficacy of fluvoxamine.Mol. Psychiatry, 3(6), 508–11.
Wang, S. L., , Huang, J. al. (1993). Molecular basis of genetic variation in debrisoquin hydroxylation in Chinese subjects: polymorphism in RFLP and DNA sequence of CYP2D6.Clin. Pharmacol. Ther., 53(4), 410–18.
Xie, H. G., , Stein, C. al. (1999). Allelic, genotypic and phenotypic distributions of S-mephenytoin 4′-hydroxylase (CYP2C19) in healthy Caucasian populations of European descent throughout the world.Pharmacogenetics, 9(5), 539–49.
Yoshida, K., , Ito, al. (2002). Influence of the serotonin transporter gene-linked polymorphic region on the antidepressant response to fluvoxamine in Japanese depressed patients.Prog. Neuropsychopharmacol. Biol. Psychiatry, 26(2), 383–6.
Yu, Y. W., , Tsai, S. al. (2002). Association study of the serotonin transporter promoter polymorphism and symptomatology and antidepressant response in major depressive disorders.Mol. Psychiatry, 7(10), 1115–19.
Zanardi, R., , Serretti, al. (2001). Factors affecting fluvoxamine antidepressant activity: influence of pindolol and 5-HTTLPR in delusional and nondelusional depression.Biol. Psychiatry, 50(5), 323–30.
Zevin, S. & , Benowitz, N. L. (1999). Drug interactions with tobacco smoking. An update.Clin. Pharmacokinet., 36(6), 425–38.