As noted, these reports are often compromised by small or biased samples, lack of standardized depression assessments, and by the high

prevalence of depression in the medically ill. Often, when prospective studies are performed, these agents do not in fact appear to cause depression in most patients, and their use should not be avoided in patients at risk for depression, especially if they are important for the treatment of the underlying medical condition. Unfortunately, few prospective studies – especially challenge-dechallenge-rechallenge Inhibitors,research,lifescience,medical trials – have been performed to evaluate the psychiatric effects of Selleck SCR7 medications purported to cause depression. The lack of confirmation by prospective studies highlights the importance of the systematic evaluation of psychiatric side effects of medications, Inhibitors,research,lifescience,medical as basing clinical practice on case reports often can lead to withholding beneficial treatments for fear of rare side effects. However, some agents appear to cause depression

in a minority of patients. These agents include barbiturates, vigabatrin, topiramate, flunarizine, corticosteroids, mefloquine, efavirenz, and IFN-α. These agents Inhibitors,research,lifescience,medical should be used more cautiously in patients with current or prior depression, or those who are otherwise at high-risk for depression. Depression is rarely an absolute contraindication to the use of a medication, but several factors should be weighed by clinicians to make the best prescribing decision for a given patient. These factors include the extent of potential benefit of the medication on the medical condition, the existence of nondepressogenic alternative medications Inhibitors,research,lifescience,medical to treat the condition,

the patient’s history of depression (and severity of prior depressive episodes), and the ability to monitor the patient for depression. Inhibitors,research,lifescience,medical Finally, one final clinical caveat: though a certain medication may not cause a depressive syndrome in the general population, idiosyncratic reactions can occur as the result of genetic vulnerabilities and environmental stressors (eg, concurrent medications). Therefore, if a patient develops depressive symptoms after the initiation of a given agent (especially second after an’on-off-on’ trial suggesting consistent onset of depression with the medication), another agent should be strongly considered.
In a landmark article published in 2004, Lawrence J. Lesko and Janet Woodcock, from the United States Food and Drug Administration (FDA), defined pharmacogenomics broadly as “the study of inter-individual variations in whole-genome or candidate gene single-nucleotide polymorphism (SNP) maps, haplotype markers and alterations in gene expression or inactivation that might be correlated with pharmacological function and therapeutic response.