The pharmacogenomics of depression: mapping the social and ethical impact
| Published date | 01 September 2005 |
| DOI | https://doi.org/10.1108/17465729200500022 |
| Date | 01 September 2005 |
| Pages | 33-41 |
| Author | Michael Barr,Ilina Singh,Nikolas Rose |
| Subject Matter | Health & social care |
Michael Barr
Post-doctoral researcher
officer
Ilina Singh
Senior research
(GENDEP)
Nikolas Rose
Director
BIOS Centre,
London School of
Economics
Correspondence to:
Michael Barr
BIOS Centre
London School of
Economics
Houghton Street
London WC2A 2AE
em.t.barr@lse.ac.uk
PHARMACOGENOMICS
33
journal of public mental health
vol 4 • issue 3
©Pavilion Publishing (Brighton) Ltd
Depression can vary in type (unipolar or
bipolar), incidence (episodic, recurrent or
chronic) and severity (mild, moderate or
severe). In this paper we refer mainly to
conditions of unipolar depression that are
considered severe enough to warrant treatment with
antidepressant medication. However,in the conclusion,
we briefly address how the severity of depression may
affect preferred therapeutic options.
It is estimated that at least one in five persons will
suffer from depression at some point in their lives. By
2020 the World Health Organisation estimates that
depression will account for nearly six per cent of the
global disease burden and will rank second only to
ischaemic heart disease as the leading cause of years lost
to disability (WHO, 2001). Some commentators see the
climbing rates of depression, in the western world at
least, as a consequence of our times – the competing
demands of work and family, a growing alienation from
traditional structures, and the complex chaos of
technological life (Solomon, 2002). Whatever the
cause, anyone who has suffered from depression or cared
for a depressed person knows the high price the illness
exacts. Depression, particularly in its more severe forms,
is a disease that paralyses the will, creates pain
disproportionate to plight, and is meaninglessness and
incomprehensible to those without direct experience of
it. The fact that depression is a serious risk factor for
another major killer, heart disease, makes its impact
seem particularly virulent (Pratt et al, 1996).
Given the rise in diagnoses of depression, it is not
surprising that the use of antidepressant medication has
also risen sharply in recent years. (We by no means
attribute the rise in antidepressant use merely to higher
rates of depression. Antidepressants are commonly
prescribed for other conditions such as panic attacks,
social phobias, and obsessive-compulsive disorders. We
return to this topic at the end of the paper.) In the US,
antidepressant use has tripled in the last decade.
Currently,one out of every ten women in the US is
taking an antidepressant (Washington Post, 2004). In
England, 8.2 million prescriptions were dispensed in
1999; by 2003 this figure had jumped to over 19 million
(MHRA, 2004). Yet with more than a dozen different
types of antidepressants on licence, there still exists no
clear criterion for practitioners to know which drug to
give to which patient. Thus, physicians often rely on
guesswork and personal preference when prescribing.
There is no guesswork, however,as to the profits
involved. The drug Prozac alone earns $2.6 billion
annually for its manufacturers Eli Lilly and Company. In
total, the European market for psychotropic drugs
reached $4,741 million in 2000 (Rose, 2005a; Rose,
2005b).
The pharmacogenomics of
depression: mapping the
social and ethical impact
Depressive disorders are a focus of growing social and economic concern.While antidepressant
medications are widely accepted, they are ineffective for nearly 40% of users, and cause numerous
adverse drug reactions.The pharmacogenomics of depression attempts to better understand the
role of genetic variation in antidepressant metabolism in the hope of improving drug efficacy and
tolerability.However, the development and delivery of genome-based antidepressants face many
hurdles. In this paper weprovide an overview of the potential impact of the pharmacogenomics of
depression on public mental health care by focusing on the social and ethical issues at stake.These
include questions about genetic testing, informed consent,drug access, and market fragmentation.
Weend the paper with a brief discussion of the wider context and how the pharmacogenomics of
depression relates to broader trends in psychiatry and biomedicine.
Key words:
pharmacogeno-mics
genetic testing
biomedical ethics
depression
antidepressant medication
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