THE PHARMACOLOGICAL TREATMENT OF ANXIETY AND DEPRESSION IN AFRICAN-AMERICANS - CONSIDERATIONS FOR THE GENERAL-PRACTITIONER

A growing pool of recent research points to the importance of ethnicit y in psychopharmacologic management of depression and anxiety disorder s, with sometimes profound implications for efficacy and safety. Such research has provided provocative findings that illustrate important i nterethnic pharmacogenetic, pharmacokinetic, and pharmacodynamic diffe rences, especially for African Americans. We did a systematic literatu re review of psychopharmacologic treatment considerations among Africa n Americans with anxiety and mood disturbance seen by primary care phy sicians, who provide most psychopharmacologic treatment. The findings commonly point to a greater percentage of ''poor metabolizers'' among African Americans compared with Euro-Americans. General treatment cons iderations include greater attention to adverse effects and better cli nical response and poorer compliance for a given dose, potential need for lower starting doses and slower increases, use of plasma drug leve ls if available, determination of past responses to a similar drug, an d integration of pharmacogenetic information into an overall sociocult urally and ethnically sensitive approach to assessment and treatment.