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Pharmakogenetik in der Psychiatrie: eine Standortbestimmung

Pharmacogenetics in psychiatry: state of the art

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Zusammenfassung

In der vorliegenden Arbeit aus dem Referat Neurobiologie und Genetik der Deutschen Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) wird der Stand der Literatur zur Bedeutung pharmakogenetischer Befunde zur Pharmakokinetik und Pharmakodynamik von Antidepressiva, Antipsychotika und Lithium zusammengefasst. Besonders hingewiesen wird auf die Arbeit internationaler Expertengruppen und Regulierungsbehörden. In Deutschland liegt eine erste Stellungnahme der Gendiagnostikkommission des Gesundheitsministeriums am Robert-Koch-Institut vor. Die DGPPN hat im Anhörungsverfahren die Empfehlung zur CYP2D6-Bestimmung vor dem Einsatz trizyklischer Antidepressiva unterstützt und empfiehlt darüber hinaus bei asiatischen Patienten vor einem Einsatz von Carbamazepin die Bestimmung des HLA-B*1502-Genotyps. Haupthindernis für den flächendeckenden Einsatz pharmakogenetischer Bestimmungen für eine sicherere und effektivere Pharmakotherapie psychischer Erkrankungen ist das Fehlen prospektiver Studien zu einzelnen und vor allem zu der Kombination genetischer Varianten. Hier sind Psychiater, Humangenetiker und Drittmittelgeber im Interesse der Patienten gefordert.

Abstract

In this article, the current literature on pharmacogenetics of antidepressants, antipsychotics and lithium are summarized by the section of Neurobiology and Genetics of the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN). The publications of international expert groups and regulatory authorities are reviewed and discussed. In Germany, a statement on pharmacogenetics was also made by the gene diagnostics committee of the Ministry of Health. The DGPPN supports two recommendations: 1) to perform CYP2D6 genetic testing prior to prescription of tricyclic antidepressants and 2) to determine the HLA-B*1502 genotype in patients of Asian origin before using carbamazepine. The main obstacle for a broad application of pharmacogenetic tests in psychiatry remains the lack of large prospective studies, for both single gene-drug pair and cobinatorial pharmacogenetic tests, to evaluate the benefits of genetic testing. Psychiatrists, geneticists and funding agencies are encouraged to increase their efforts for the future benefit of psychiatric patients.

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Authors and Affiliations

  1. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., R132, Toronto, ON, M5T 1R8, Kanada

    D. J. Müller

  2. Department of Psychiatry, University of Toronto, Toronto, ON, Kanada

    D. J. Müller

  3. Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland

    E. J. Brandl

  4. Berlin Institute of Health, Berlin, Deutschland

    E. J. Brandl

  5. Institut für Humangenetik, Universitätsklinikum Bonn, Bonn, Deutschland

    F. Degenhardt

  6. Klinik für Psychiatrie und Psychotherapie, Universität Freiburg, Freiburg, Deutschland

    K. Domschke & L. Tebartz van Elst

  7. Klinik und Poliklinik für Psychiatrie und Psychotherapie an der Universitätsmedizin Greifswald, Universität Greifswald, Greifswald, Deutschland

    H. Grabe

  8. Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    O. Gruber

  9. Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    J. Hebebrand

  10. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland

    W. Maier

  11. Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Zentrum für Psychische Gesundheit, Universitätsklinikum Würzburg, Würzburg, Deutschland

    A. Menke & J. Deckert

  12. Klinik für Psychiatrie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland

    M. Riemenschneider

  13. Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland

    M. Rietschel

  14. Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland

    D. Rujescu

  15. Institut für Psychiatrische Phänomik und Genomik (IPPG), Klinikum der Universität München, LMU München, München, Deutschland

    T. G. Schulze

  16. Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin der Johannes-Gutenberg Universität, Mainz, Deutschland

    O. Tüscher

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das DGPPN Referat Neurobiologie und Genetik

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Correspondence to D. J. Müller.

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D.J. Müller, E.J. Brandl, F. Degenhardt, K. Domschke, H. Grabe, O. Gruber, J. Hebebrand, W. Maier, A. Menke, M. Riemenschneider, M. Rietschel, D. Rujescu, T.G. Schulze, L. Tebartz van Elst, O. Tüscher und J. Deckert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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D. J. Müller und E. J. Brandl teilen sich die Erstautorenschaft.

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Müller, D.J., Brandl, E.J., Degenhardt, F. et al. Pharmakogenetik in der Psychiatrie: eine Standortbestimmung. Nervenarzt 89, 290–299 (2018). https://doi.org/10.1007/s00115-017-0479-8

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