• Personalized Treatment Optimization in Psychiatry: A Review of Therapeutic Drug Monitoring, Pharmacogenomics, and Biomarker Testing
  • Samin Hamidi,1,*
    1. Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran


  • Introduction: Personalized treatment optimization in psychiatry addresses the critical challenge of suboptimal effectiveness and variable patient responses to psychiatric medications, potentially revolutionizing mental health care. Mental disorders such as depression, bipolar disorder, and schizophrenia affect millions of people worldwide, causing significant personal suffering and societal burden. Traditional approaches to psychiatric treatment often involve a trial-and-error process, where medications are prescribed based on general guidelines and adjusted according to patient response. This method can lead to prolonged periods of inadequate symptom control, increased risk of side effects, and poor treatment adherence. The concept of personalized treatment optimization aims to tailor pharmacological interventions to individual patients based on their unique genetic, physiological, and environmental factors. By leveraging advanced analytical techniques and genetic testing methodologies, clinicians can potentially predict which medications are most likely to be effective for a given patient while minimizing the risk of adverse effects. This approach holds the promise of improving treatment outcomes, reducing the time to achieve symptom remission, and enhancing overall quality of life for individuals with mental health disorders.
  • Methods: This review examines three primary approaches to personalized treatment optimization in psychiatry: therapeutic drug monitoring, pharmacogenomics, and biomarker testing. Each of these methods contributes valuable information to guide clinical decision-making and treatment planning. Therapeutic drug monitoring involves measuring the concentration of psychiatric medications in a patient's blood or plasma. This technique allows clinicians to ensure that drug levels are within the therapeutic range, optimizing efficacy while minimizing toxicity. Advanced analytical methods such as liquid chromatography and mass spectrometry are employed to accurately quantify drug concentrations. These techniques offer high sensitivity and specificity, enabling precise measurements of multiple drugs and their metabolites simultaneously. Pharmacogenomics focuses on identifying genetic variations that influence an individual's response to psychiatric medications. This approach involves analyzing specific genes associated with drug metabolism, transport, and targets. Genetic testing methodologies, including polymerase chain reaction (PCR) and next-generation sequencing, are used to detect relevant genetic polymorphisms. By understanding a patient's genetic profile, clinicians can predict how they might metabolize certain medications and adjust dosages accordingly. Biomarker testing involves measuring biological indicators that can provide insights into a patient's disease state, treatment response, or risk of adverse effects. In psychiatry, biomarkers may include neurotransmitter levels, inflammatory markers, or neuroimaging findings. Various analytical techniques, such as enzyme-linked immunosorbent assays (ELISA), electroencephalography (EEG), and functional magnetic resonance imaging (fMRI), are employed to assess these biomarkers.
  • Results: The review of current evidence supporting personalized approaches in clinical practice reveals promising findings across various psychiatric disorders. In depression, studies have shown that therapeutic drug monitoring can improve treatment outcomes by ensuring adequate drug concentrations and guiding dose adjustments. Pharmacogenomic testing has demonstrated potential in predicting antidepressant response and side effect risk, with some genetic variants associated with increased likelihood of remission or adverse reactions. For bipolar disorder, therapeutic drug monitoring has proven particularly valuable in managing lithium therapy, a medication with a narrow therapeutic index. Genetic testing has identified polymorphisms that may influence response to mood stabilizers and antipsychotics commonly used in bipolar treatment. Biomarker research has explored the use of inflammatory markers and neuroimaging findings to predict treatment response and differentiate bipolar subtypes. In schizophrenia, personalized treatment optimization has shown promise in managing antipsychotic therapy. Therapeutic drug monitoring helps clinicians maintain optimal drug levels, particularly for clozapine, which requires careful monitoring due to its side effect profile. Pharmacogenomic studies have identified genetic variants associated with antipsychotic response and metabolic side effects. Biomarker research in schizophrenia has explored the use of neuroimaging and cognitive measures to predict treatment outcomes and guide medication selection.
  • Conclusion: While personalized treatment optimization shows considerable promise in enhancing therapeutic outcomes and minimizing adverse effects in psychiatry, further research is needed to establish its clinical utility and cost-effectiveness across various disorders. The integration of therapeutic drug monitoring, pharmacogenomics, and biomarker testing into clinical practice has the potential to significantly improve patient care by enabling more precise and individualized treatment strategies. However, several challenges must be addressed before personalized treatment optimization can fully transform the mental health treatment landscape. These include the need for larger, well-designed clinical trials to validate the efficacy of personalized approaches, the development of standardized testing protocols and interpretation guidelines, and the education of healthcare providers on the appropriate use and interpretation of personalized treatment data. As evidence accumulates and technologies advance, these approaches may become increasingly integrated into standard psychiatric care. The future of personalized treatment optimization in psychiatry holds the potential to revolutionize mental health care, offering hope for improved outcomes and quality of life for individuals living with mental health disorders. Ongoing research and clinical implementation efforts will be crucial in realizing this potential and shaping the future of psychiatric treatment.
  • Keywords: Biomarker, Pharmacogenetic, Therapeutic Drug Monitoring, Psychiatry, Personalized Medicine