Variations In Antidepressant Prescribing Suggest Disparities In Provision Of Care

GPs prescribe lower volumes of antidepressants in areas with more Black or South Asian people, suggesting possible disparities in the provision of care.

The study, published in the September issue of the British Journal of Psychiatry, also reveals that higher volumes of antidepressants are prescribed by general practices in economically deprived areas, and by practices serving areas with a high prevalence of chronic illness.

Researchers from King's College London set out to explore the relationship between physical illness, social deprivation, ethnicity, practice characteristics and the volume of antidepressants prescribed in primary care.

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Antipsychotics Found to Have Different Ethnic and Metabolic Profiles: Presented at APA

Antipsychotic medications have different effects depending on the patient's specific metabolism and ethnicity, according to a post-hoc analysis of a randomized trial that compared aripiprazole and olanzapine reported here at the 161st Annual Meeting of the American Psychiatric Associations (APA).

The study compared the metabolic and racial and/or ethnic effects of 2 antipsychotic medications -- olanzapine and aripiprazole -- that are both approved by the US Food and Drug Administration for treatment of schizophrenia.

In the 26-week, double-blind, randomized, controlled trial, the effects of aripiprazole and olanzapine were compared in patients who had been grouped according to their ethnicity -- "White/Other" (n = 67); "Black" (n = 86); "Hispanic" (n = 51)

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Genetic variant predicts antipsychotic response for schizophrenia patients by ethnicity

Schizophrenia is a developmental disorder with a large genetic component contributing to increased risk. Available antipsychotic medications treat some of the symptoms of schizophrenia, but are typically effective in only a subset of patients. Unfortunately, it is difficult to predict the effectiveness of a specific drug in any given individual with schizophrenia. John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, notes that “in this era of medicine, the selection of particular antipsychotic medications for particular patients with schizophrenia is more art than science. We have been seeking objective guides, perhaps biological tests, which would inform this process.” A new study published in the January 1st issue of Biological Psychiatry provides some interesting data to aid in that goal.

The authors report that differential effectiveness of antipsychotic treatment was predicted, in a subset of patients with schizophrenia, by variants of the gene encoding for the regulator of G-protein signaling 4 (RGS4), a protein that regulates the functional consequences of activating neurotransmitter receptors. Dr. Daniel Campbell, corresponding author for this article, explains these results: “By applying genetic analysis to the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness, we show that variants in a specific gene, RGS4, predict the effectiveness of different antipsychotic treatments. Our results also indicate that the predictive power of the RGS4 genetic variants differed between patients of self-reported African and European ancestry, and thus emphasize the importance of including multiple ethnic groups in a study.”

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