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The Ethical Ramifications of Biomarker Use for Mood Disorders

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Handbook of Schizophrenia Spectrum Disorders, Volume III

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Abstract

Over the past 20 years, researchers have made considerable progress in the search for diagnostic and prognostic biomarkers of psychiatric disorders, including major depressive disorder, bipolar disorder, and anxiety. Advocates of this research contend that identifying biomarkers will aid in the diagnosis and treatment of these disorders, as well as in the development of more effective psychiatric medications. However, the concept of biomarker testing generates significant ethical concerns, including the testing of non-symptomatic individuals, the potential for health insurance or employment discrimination, and the collection and use of genetic information. Genetic biomarkers are especially controversial since heredity information is uniquely personal – it can reveal an individual’s likely medical future; divulge personal information about one’s parents, siblings and children; and has a history of being used to stigmatize and victimize individuals. Some legal protections are already in place; however, they are far from comprehensive. For example, the US Genetic Information Nondiscrimination Act of 2008 only encompasses tests that analyze DNA, RNA, or chromosomal changes. This means that tests for non-genetic biomarkers, like those based on protein expression or post-translational modifications, are exempt. In the rush toward developing etiological screening tools, it is pertinent to remember that patients are at the heart of the medical profession, not their DNA or protein profile. Any new diagnostic tools should confer a significant benefit to patients without promoting confusion, discrimination, or stigma.

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Abbreviations

5HTT:

5-hydroxytryptamine

ABCB1:

ATB-binding cassette subfamily B member 1

ACTH:

Adrenocorticotropic hormone

BDNF:

Brain derived neurotrophic factor

BRCA:

Breast cancer gene

CRF:

Corticotropin releasing factor

DNA:

Deoxyribonucleic acid

DNMT:

DNA methyltransferase

DSM-IV:

Diagnostic and statistical manual of mental disorders

GABA:

γ-aminobutyric acid receptor

GAD-7:

Generalized anxiety disorder-7

GINA:

Genetic Information Non-discrimination Act

GR:

Glucocorticoid receptor

GWA:

Genome wide analysis

HIV:

Human immunodeficiency virus

HPA:

Hypothalamic-pituitary adrenal

MDQ:

Mood disorder questionnaire

MDR1:

Multidrug resistance 1

MR:

Mineralcorticoid receptor

mRNA:

Messenger RNA

NEO-PI:

NEO personality inventory

NPY:

Neuropeptide Y

NR3C1:

Nuclear receptor subfamily 3, group C, member 1

PHQ:

Patient health questionnaire

PPD:

Purified protein derivative

RNA:

Ribonucleic acid

SCID:

Structured clinical interview for DSM-IV

SNPs:

Single nucleotide polymorphisms

SSRIs:

Serotonin reuptake inhibitors

TB:

Tuberculosis

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  1. Global Neuroscience Initiative Foundation (GNIF), Los Angeles, CA, USA

    Shaheen E. Lakhan & Karen F. Vieira

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  1. Shaheen E. Lakhan
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Correspondence to Shaheen E. Lakhan .

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  1. , Rappaport Faculty of Medicine, Technion - Israel Institute of Technolog, Haifa, Israel

    Michael S. Ritsner

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Lakhan, S.E., Vieira, K.F. (2011). The Ethical Ramifications of Biomarker Use for Mood Disorders. In: Ritsner, M. (eds) Handbook of Schizophrenia Spectrum Disorders, Volume III. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0834-1_18

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