title: Biological variations in depression and anxiety between East and West.
abstract: Ethnicity and culture represent important factors in shaping psychopathology as well as pharmacotherapeutic responses in psychiatric patients. A large body of literature, accumulated over the past several decades, demonstrates that these factors not only determine the metabolism and disposition of medications (pharmacokinetics), but also their interactions with therapeutic targets (pharmacodynamics). This article focuses on the impact of such variations on the diagnosis and treatment of depression and anxiety disorders between East and West. Genes controlling the expression of drug metabolizing enzymes as well as the function of the brain are highly polymorphic, and the patterns and distribution of these polymorphisms are typically divergent across ethnic groups. To the extent that these genetic patterns determine drug response, ethnic variations in these genetic dispositions will lead to differential responses in clinical settings. In addition, the expression of these genes is significantly influenced by environmental factors including diet as well as exposure to other natural products. Superimposed on these biological influences, culturally determined beliefs and behavioral patterns also profoundly influence patients' expectations of treatment response, adherence, and interactions with clinicians. In addition to pharmacotherapeutic responses, emerging data also indicate that significant ethnic variations exist in genetic polymorphisms and neurobiologic correlates (biomarkers) that may be associated with the vulnerability to psychiatric disorders. These considerations argue for the importance of examining biological variations across ethnic groups, especially in the clinical context, in terms of the assessment and treatment of psychiatric patients, and in our understanding of psychiatric phenomenology and nosology.
authors.affiliation: Department of General Psychiatry, Songde Branch, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Po-Yu
authors.initials: PY
authors.lastname: Chen
authors.forename: Sheng-Chang
authors.initials: SC
authors.lastname: Wang
authors.forename: Russell E
authors.initials: RE
authors.lastname: Poland
authors.forename: Keh-Ming
authors.initials: KM
authors.lastname: Lin
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis* / Q000208:ethnology / Q000235:genetics / Q000628:therapy*; D044466:Asian People / Q000208:ethnology* / Q000235:genetics / Q000523:psychology; D003431:Cross-Cultural Comparison; D003866:Depressive Disorder / Q000175:diagnosis* / Q000208:ethnology / Q000235:genetics / Q000628:therapy*; D014644:Genetic Variation / Q000502:physiology; D006801:Humans; D044465:White People / Q000208:ethnology* / Q000235:genetics / Q000523:psychology
references.citation: Sleep. 1987 Jun;10(3):279-86
references.pmid: 3629091
references.citation: J Clin Pharmacol. 2004 Oct;44(10):1083-105
references.pmid: 15342610
references.citation: Sleep. 2002 Feb 1;25(1):89-96
references.pmid: 11833865
references.citation: J Anxiety Disord. 2008 Dec;22(8):1535-41
references.pmid: 18436428
references.citation: Biol Psychiatry. 1999 Aug 15;46(4):557-67
references.pmid: 10459407
references.citation: J Clin Psychiatry. 2001;62 Suppl 13:13-9; discussion 20-1
references.pmid: 11434414
references.citation: J Clin Psychiatry. 1983 May;44(5):173-6
references.pmid: 6853452
references.citation: Compr Psychiatry. 2000 Nov-Dec;41(6):469-78
references.pmid: 11086154
references.citation: Clin Pharmacol Ther. 1993 Nov;54(5):507-13
references.pmid: 8222493
references.citation: J Natl Med Assoc. 1988 Mar;80(3):289-94
references.pmid: 3351970
references.citation: Am J Med Genet. 1999 Dec 15;88(6):628-33
references.pmid: 10581481
references.citation: Br J Psychiatry. 1984 Jul;145:88-90
references.pmid: 6743951
references.citation: Depress Anxiety. 2005;22(2):47-51
references.pmid: 16094659
references.citation: Br J Clin Pharmacol. 1979 Mar;7(3):237-43
references.pmid: 427001
references.citation: Neuropsychopharmacology. 2000 Nov;23(5):587-90
references.pmid: 11027924
references.citation: Postgrad Med J. 1977;53 Suppl 4:79-86
references.pmid: 341109
references.citation: Arch Gen Psychiatry. 1969 Jul;21(1):89-94
references.pmid: 5815781
references.citation: J Biol Chem. 1994 Jun 3;269(22):15419-22
references.pmid: 8195181
references.citation: Mol Psychiatry. 2001 Sep;6(5):586-92
references.pmid: 11526473
references.citation: Am J Psychother. 1982 Oct;36(4):505-12
references.pmid: 7158673
references.citation: Arch Gen Psychiatry. 2005 Oct;62(10):1109-18
references.pmid: 16203956
references.citation: Clin Pharmacol Ther. 1981 Jun;29(6):749-56
references.pmid: 7226707
references.citation: Clin Pharmacol Ther. 2001 Oct;70(4):351-61
references.pmid: 11673751
references.citation: Psychopharmacol Bull. 1980 Jul;16(3):49-52
references.pmid: 7403401
references.citation: Transcult Psychiatry. 2005 Mar;42(1):46-77
references.pmid: 15881268
references.citation: Arch Gen Psychiatry. 2001 Jun;58(6):539-44
references.pmid: 11386982
references.citation: Int Clin Psychopharmacol. 2006 Mar;21(2):87-92
references.pmid: 16421459
references.citation: Genomics. 1992 Apr;12(4):822-5
references.pmid: 1572656
references.citation: Depress Anxiety. 2008;25(5):435-40
references.pmid: 17607754
references.citation: Br J Clin Pharmacol. 1995 Jul;40(1):51-8
references.pmid: 8527268
references.citation: J Clin Psychiatry. 1993 Sep;54 Suppl:50-4; discussion 55-6
references.pmid: 8407858
references.citation: Mol Psychiatry. 1998 Nov;3(6):508-11
references.pmid: 9857976
references.citation: J Clin Psychopharmacol. 1984 Jun;4(3):171-2
references.pmid: 6736279
references.citation: Am J Psychiatry. 1986 Feb;143(2):275-6
references.pmid: 3946689
references.citation: Psychiatry Res. 1999 Nov 8;88(2):95-105
references.pmid: 10622346
references.citation: Am J Pharmacogenomics. 2004;4(6):395-401
references.pmid: 15651900
references.citation: Psychiatry Res. 1998 Jun 2;79(1):1-9
references.pmid: 9676821
references.citation: J Clin Psychiatry. 1982 Nov;43(11):457-60
references.pmid: 7174623
references.citation: Postgrad Med J. 1980;56 Suppl 1:46-9
references.pmid: 7393828
references.citation: Psychiatr Genet. 2005 Mar;15(1):7-11
references.pmid: 15722951
references.citation: Sleep. 1992 Jun;15(3):217-25
references.pmid: 1621022
references.citation: Clin Pharmacol Ther. 1992 Nov;52(5):449-52
references.pmid: 1358494
references.citation: Depress Anxiety. 2000;12 Suppl 1:30-44
references.pmid: 11098412
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2005 Dec;40(12):972-9
references.pmid: 16249971
references.citation: Cult Med Psychiatry. 1978 Mar;2(1):15-39
references.pmid: 699620
references.citation: J Pharmacol Exp Ther. 1996 Jul;278(1):441-6
references.pmid: 8764380
references.citation: Am J Med Genet. 2000 Oct 9;96(5):599-603
references.pmid: 11054766
references.citation: Arch Gen Psychiatry. 1987 Sep;44(9):790-5
references.pmid: 3632252
references.citation: Acta Psychiatr Scand. 1985 Feb;71(2):171-5
references.pmid: 3976409
references.citation: Hosp Community Psychiatry. 1986 Jan;37(1):50-4
references.pmid: 2867967
references.citation: Cult Divers Ment Health. 1997;3(1):69-76
references.pmid: 9231535
references.citation: Biol Psychiatry. 2003 Nov 1;54(9):879-83
references.pmid: 14573314
references.citation: J Clin Psychiatry. 2001;62 Suppl 13:47-55
references.pmid: 11434419
references.citation: JAMA. 1977 Nov 14;238(20):2167-9
references.pmid: 578829
references.citation: Can J Physiol Pharmacol. 1980 Sep;58(9):1142-4
references.pmid: 7459706
references.citation: Pharmacogenetics. 1997 Feb;7(1):59-64
references.pmid: 9110363
references.citation: Biol Psychiatry. 2001 Sep 1;50(5):323-30
references.pmid: 11543734
references.citation: Biol Psychiatry. 2004 Aug 15;56(4):217-24
references.pmid: 15312808
references.citation: Brain Res Bull. 1997;44(5):561-71
references.pmid: 9365799
references.citation: Ther Drug Monit. 2000 Apr;22(2):202-8
references.pmid: 10774634
references.citation: J Clin Psychiatry. 2005 Oct;66(10):1228-33
references.pmid: 16259535
references.citation: J Clin Psychiatry. 1994 Dec;55 Suppl:38-45; discussion 46-7
references.pmid: 7814357
references.citation: Psychopharmacology (Berl). 1997 Feb;129(3):265-70
references.pmid: 9084065
references.citation: Sleep. 1994 Oct;17(7):609-13
references.pmid: 7846458
references.citation: Mol Psychiatry. 1998 May;3(3):186-9
references.pmid: 9672885
references.citation: Psychopharmacology (Berl). 1988;96(3):365-9
references.pmid: 3146770
references.citation: Psychopharmacol Bull. 1979 Oct;15(4):40-1
references.pmid: 515311
references.citation: Dis Nerv Syst. 1971 Oct;32(10):655-67
references.pmid: 5146422
references.citation: J Affect Disord. 1986;Suppl 2:S1-67
references.pmid: 2940279
references.citation: Afr J Med Med Sci. 1997 Mar-Jun;26(1-2):43-5
references.pmid: 10895228
references.citation: Psychiatr Serv. 1998 Feb;49(2):239-40
references.pmid: 9575014
references.citation: Am J Med Genet. 2000 Feb 7;96(1):102-7
references.pmid: 10686561
references.citation: J Natl Med Assoc. 1984 May;76(5):501-8
references.pmid: 6737506
references.citation: Psychol Rep. 2004 Aug;95(1):317-22
references.pmid: 15460387
references.citation: Br J Psychiatry. 1991 Oct;159:505-9
references.pmid: 1751860
references.citation: Int Clin Psychopharmacol. 1999 Nov;14(6):321-7
references.pmid: 10565798
references.citation: Am J Health Syst Pharm. 2002 Nov 1;59(21):2061-9
references.pmid: 12434718
references.citation: J Anxiety Disord. 2006;20(5):687-93
references.pmid: 16099138
references.citation: Behav Ther. 2008 Dec;39(4):386-97
references.pmid: 19027435
references.citation: Psychopharmacol Bull. 1996;32(2):253-7
references.pmid: 8783895
references.citation: Lancet. 1993 Feb 13;341(8842):406-7
references.pmid: 8094172
references.citation: Nature. 1990 Oct 25;347(6295):773-6
references.pmid: 1978251
references.citation: Br J Clin Pharmacol. 1995 Nov;40(5):489-93
references.pmid: 8703655
references.citation: Clin Pharmacol Ther. 1978 Sep;24(3):283-6
references.pmid: 688721
references.citation: Arch Biochem Biophys. 2000 Aug 15;380(2):303-8
references.pmid: 10933885
references.citation: Eur J Clin Pharmacol. 1987;32(2):211-5
references.pmid: 3108012
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 1994 Sep;18(5):899-914
references.pmid: 7972860
references.citation: Clin Pharmacol Ther. 1993 Apr;53(4):410-8
references.pmid: 8097442
references.citation: Arch Gen Psychiatry. 1975 May;32(5):643-9
references.pmid: 1092283
references.citation: Clin Pharmacol Ther. 2006 Jul;80(1):33-40
references.pmid: 16815315
references.citation: Psychopharmacol Bull. 1979 Oct;15(4):32-5
references.pmid: 515308
references.citation: Biol Psychiatry. 1995 Sep 15;38(6):391-403
references.pmid: 8547459
references.citation: Transcult Psychiatry. 2005 Mar;42(1):123-34
references.pmid: 15881272
references.citation: Am J Psychiatry. 1985 Feb;142(2):268
references.pmid: 3970256
references.citation: Arch Gen Psychiatry. 1996 Feb;53(2):99-108
references.pmid: 8629894
references.citation: Clin Pharmacol Ther. 1998 Apr;63(4):444-52
references.pmid: 9585799
references.citation: Biol Psychiatry. 2002 May 1;51(9):723-32
references.pmid: 11983186