Personalized Treatment of Mental Illness: Genetics, Biomarkers and Drug Monitoring

Dear Colleagues,

Psychological characteristics, behavior, and irregularities known as mental disorders are complex traits. They are controlled by many neurochemical mechanisms and genetic variants. The choice of therapy has long been made according to diagnoses that are based on behavioral criteria and thus cannot consider the molecular heterogeneity of mental disorders. Today, genetic, biochemical and neuroimaging tools are expected to facilitate an objective choice in personalized therapeutic strategies.

One of the most significant individual characteristics that influence the effectiveness and safety of pharmacological therapy for mental disorders are differences in drug metabolism. Genetic variance, drug–drug interactions, substances of abuse, and even natural compounds, such as herbs and food, have been shown to affect the metabolism of psychotropic medicines. Therapeutic drug monitoring which consists in measuring drug concentration in blood is fast becoming crucial in mental health treatment. It helps to adjust individual dosage, identify inefficient therapy and prevent toxicity often arising from the use of certain antidepressants and mood stabilizers, and minimize side-effects of many neuroleptics. The action of psychotropic drugs also depends on delivery into brain tissue that is affected by binding to plasma proteins and the activity of transporters.

Model-informed decision making is the best way to consider a big number of variables to precisely adjust drug dosage. These models are widely used in some areas such as antimicrobial therapy or renal failure but are still pending in psychopharmacology. Developing a good physiologically based model requires two essential steps. The first step is identifying the key variables that affect drug action, such as genotypes or kidney function. The second step is a validation of the model using empirical data. Insights into the mechanism of psychotropic drug metabolism are essential for the first step, and both steps require universal datasets containing real patients’ data. This is why it is important to publish research on individual differences in the action of psychopharmacologic drugs and create theories about their nature including from experimental works and clinical cases.

This Special Issue welcomes research on individual differences in genetics and endogenous or exogeneous biomarkers, especially drug concentrations, that may improve therapy effectiveness and safety for a given patient suffering from a mental disorder.

Research papers, reviews, and descriptions of clinical cases are kindly invited.

Dr. Alexey Piskunov
Guest Editor

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• psychotropic drugs
• mental disorders
• individual differences
• genetics