Pharmacogenetic testing in psychiatric practice

Successful treatment of the most mental disorders requires selection of the most effective and safe psychopharmacotherapy that allows achieving satisfactory patient compliance. However, despite the emergence of new generations of psychotropic drugs, the problem of insufficient efficacy and adverse drug reactions remains unresolved. About a quarter of the total variability in response to psychotropic drugs is of genetic origin. Determination of individual characteristics of the patient’s genotype is possible using pharmacogenetic testing — identification of specific genotypes based on polymerase chain reaction. The review analyzes and summarizes the results of domestic and foreign studies of the role of pharmacogenetic testing in determining the polymorphism of genes that affect the metabolism of psychotropic drugs by changing the activity of cytochrome р450 isoenzymes and transporter proteins. Key enzymes of the metabolism of antipsychotics and antidepressants registered for use in Russia are presented. The prospects of various options for pharmacogenetic testing in reducing the risk of potentially fatal complications in the selection of psychopharmacotherapy in clinical practice are assessed. The possibility of conducting pharmacogenetic testing at the initial stages of therapy is a promising direction for improving psychiatric care, corresponding to the modern paradigm of personalized medicine.