Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Italy.
University of Unicamillus, Rome, Italy.
CNS Spectr. 2021 Jun;26(3):222-231. doi: 10.1017/S1092852920000073. Epub 2020 Mar 2.
Ethnic differences may significantly influence the outcome of psychopharmacological treatment, in terms of prescription, adherence, clinical response, emergence of side effects, as well as pharmacokinetics and pharmacodynamics. The purpose of this review was to explore the available literature in order to provide general suggestions to help clinicians in choosing the best therapeutic option for patients, taking into account ethnicity. Although findings are sometimes controversial, the overall published studies suggest that ethnicities other than Caucasians tend to show a lower response to antidepressants and a reduced compliance. Africans tend to be more prescribed with antipsychotics, probably due to cultural stereotypes, except with clozapine, probably for their chronic benign neutropenia. Asians usually require less antipsychotic dosages than Caucasians. The differential response and side effect profile of antidepressants and antipsychotics have been related to individual intrinsic factors, to genetic make-up, but also to cultural and contextual variables. Interestingly, albeit limited data suggest ethnic-related genetic heterogeneity at the level of the serotonin transporters, the cytochromes and some neuroreceptors. Taken together, no conclusive findings are available about the role and impact of ethnicity in psychopharmacology. One of the main problems is that the majority of the studies in psychopharmacology have been conducted on Caucasians, so that there is an urgent need to have data in other populations. Furthermore, in the era of precision medicine, the role of ethnicity may be also supported by genetic analysis.
种族差异可能会显著影响精神药理学治疗的结果，包括处方、依从性、临床反应、副作用的出现，以及药代动力学和药效学。本综述的目的是探讨现有文献，为临床医生提供一般性建议，帮助他们根据种族因素选择最佳的治疗选择。尽管研究结果有时存在争议，但已发表的总体研究表明，除了白种人以外，其他种族的人对抗抑郁药的反应较低，依从性也较低。非洲人倾向于更多地被开抗精神病药，这可能是由于文化刻板印象，除了氯氮平，可能是因为他们的慢性良性中性粒细胞减少症。亚洲人通常需要的抗精神病药剂量比白种人少。抗抑郁药和抗精神病药的不同反应和副作用模式与个体内在因素、遗传构成有关，但也与文化和环境变量有关。有趣的是，尽管数据有限，但表明在 5-羟色胺转运体、细胞色素和一些神经受体水平上存在与种族相关的遗传异质性。总之，关于种族在精神药理学中的作用和影响尚无定论。主要问题之一是精神药理学中的大多数研究都是在白种人身上进行的，因此迫切需要在其他人群中获得数据。此外，在精准医学时代，种族的作用也可能得到遗传分析的支持。
