Culture, Medicine and Psychiatry

, Volume 10, Issue 2, pp 151–165 | Cite as

Ethnicity and psychopharmacology

  • Keh-Ming Lin
  • Russell E. Poland
  • Ira M. Lesser


In clinical studies and cross-national surveys, cultural or ethnic factors have been found to be significant determinants in patients' responses to psychotropic medication. Dosage requirements and the potential for toxic reactions might differ amongst racial and ethnic groups. In this paper, the authors review the relevant literature and examine pharmacodynamic, pharmacokinetic and cultural-psychological factors, all of which could be responsible for such ethnic variations.


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  1. Allen, J. J., Rack, P. H., and Vaddadi, K. S. 1977 Differences in the effects of clomipramine on English and Asian volunteers: preliminary report on a pilot study. Postgraduate Medical Journal 53 (suppl. 4): 79–86.Google Scholar
  2. Bertilson, L., Eichelbaum, M., Mellstone, B., et al. 1980 Nortriptyline and antipyrine clearance in relation to debrisoquine hydroxylation in man. Life Sciences 27: 1673–1677.Google Scholar
  3. Binder, R. L. and Levy, R. 1981 Extrapyramidal reactions in Asians. Americal Journal of Psychiatry 138, 1243–1244.Google Scholar
  4. Brauch, R. A., Salih, S. Y., and Momeida, M. 1978 Racial differences in drug metabolizing ability: a study with antipyrine in the Sudan. Clinical Pharmacology and Therapeutics 24: 283–286.Google Scholar
  5. Chafetz, M. D. 1964 Consumption of alcohol in the Far and Middle East. New England Journal of Medicine 271: 297–301.Google Scholar
  6. Chang, S. S., Pandey, G. N., Zhang, M., Ku, M., and Davis, J. M.: Racial difference in plasma and RBC lithium levels. Presented at the 137th annual meeting of the American Psychiatric Association, Los Angeles, CA, May 7–11, 1984.Google Scholar
  7. Chang, S. S., Pandey, G. N., Yang, Y. Y., Yeh, E. K., and Davis, J. M.: Lithium Pharmacokinetics: inter-racial comparison. Presented at the 138th annual meeting of the American Psychiatric Association, Dallas, Texas, May 19–24, 1985.Google Scholar
  8. Collard, J. 1962 Drug responses in different ethnic groups. Journal of Neuropsychiatry 3 (suppl. 1): 114–121.Google Scholar
  9. Davidson, J., Mcleod, M. N., and Blum, M. R. 1978 Acetylation phenotype, platelet monoamine oxidase inhibition, and the effectiveness of phenelzine in depression. American Journal of Psychiatry 135: 467–469.Google Scholar
  10. Deleve, L. D., and Piafsky, K. M. 1981 Clinical significance of plasma binding of basic drugs. Trends in Pharmacological Sciences 2: 283–284.Google Scholar
  11. Denber, H. C. B., Bente, D., and Rajotte, P. 1962 Comparative analysis of the action of butyrylperazine at Manhattan State Hospital and the University Psychiatric Clinic at Erlangen. American Journal of Psychiatry 119: 203–206.Google Scholar
  12. Denber, H. C. B. and Bente, D. 1967Clinical response to pharmacotherapy in different settings, in Neuropsychopharmacology. H. Brill et al., eds. New York: Excerpta Medica Foundation.Google Scholar
  13. Favazza, A. R., and Oman, M. 1977 Anthropological and Cross-Cultural Themes in Mental Health. An Annotated Bibliography, 1925–1974. Columbia: University of Missouri Press.Google Scholar
  14. Favazza, A. R. and Faheem, A. D. 1982 Themes in Cultural Psychiatry. An Annotated Bibliography, 1975–1980. Columbia: University of Missouri Press.Google Scholar
  15. Fieve, R. R. 1980 Lithium therapy, in Comprehensive Textbook of Psychiatry/III. HI Kaplan, AM Freedman, BJ Sadock, eds. Baltimore/London: Williams & Wilkins.Google Scholar
  16. Forsman A., and Ohman, R. 1977 Studies on serum protein binding of haloperidol. Current Therapeutic Research 21: 245–255.Google Scholar
  17. Fraser, H. S., Mucklow, J. C. Bulpitt, C. J., et al. 1977 Environmental effects on antipyrine half-life in man. Clinical Pharmacology and Therapeutics 22: 799–808.Google Scholar
  18. Frostad, A. L., Forest, G. L., and Bakker, C. B. 1966 Influence of personality type on drug response. American Journal of Psychiatry 122: 1153–1158.Google Scholar
  19. Gaviria, M., Javaid, J., and Gil, A. 1984Javaid J and Gil A: Pharmacokinetics of Antidepressants Among Latino Subjects. Presented at the Annual Meeting of Society for the Study of Psychiatry and Culture. Santa Fe, N. M., September 26–29.Google Scholar
  20. Gaw, A. 1982 Cross-Cultural Psychiatry. Boston: John-Wright PSG Inc.Google Scholar
  21. Ghoneim, M. M., Korttila, K., Chiang, C-K., et al. 1981 Diazepam effects and kinetics in Caucasians and Orientals. Clinical Pharmacology and Therapeutics 29: 749–756.Google Scholar
  22. Gibaldi, M., and Levy, G. 1978 Effect of plasma protein and tissue binding on the biologic half-life of drugs. Clinical Pharmacology and Therapeutics 24: 1–4.Google Scholar
  23. Goth, A. 1981 Medical Pharmacology. Principles and Concepts. 10th edition. St. Louis/Toronto/London: The C. V. Mosby Co.Google Scholar
  24. Heilizer, F. 1960 A critical review of some published experiments with chlorpromazine in schizophrenic, neurotic and normal humans. Journal of Chronic Diseases 11: 102–148.Google Scholar
  25. Heninger, G., Dimascio, A., and Klerman, G. L. 1965 Personality factors in variability of response to phenothiazines. American Journal of Psychiatry 121: 1091–1094.Google Scholar
  26. Itil, T. M. (ed) 1975 Transcultural Neuropsychopharmacology. Istanbul, Turkey: Bozak Publishing Co.Google Scholar
  27. Itil, T. M. 1983Transcultural Psychopharmacology: A Potpourri of Recent Studies. American College of Neuropsychopharmacology. 22 nd Annual Meeting, San Juan, Puerto Rico, December 12–16.Google Scholar
  28. Johnstone, E. C., Marsh, W. 1973 Acetylator status and response to phenelzine in depressed patients. Lancet 6: 567–570.Google Scholar
  29. Joralemon, D. 1984 The Role of Hallucinogenic Drugs and Sensory Stimuli in Peruvian Ritual Healing. Culture, Medicine and Psychiatry 8: 399–430.Google Scholar
  30. Kalow, W. 1982 Ethnic differences in drug metabolism. Clinical Pharmacokinetics 7: 373–400, 1982.Google Scholar
  31. Leff, J. 1981 Psychiatry Around the Globe. New York: Marcel Dekker.Google Scholar
  32. Lewis, P., Rack, P. H., Vaddadi, K. S., et al. 1980 Ethnic differences in drug response. Postgraduate Medical Journal 56 (suppl. 1): 46–49.Google Scholar
  33. Lin, K. M., and Finder, E. J. 1983 Neuroleptic dosage in Asians. American Journal of Psychiatry 140: 490–491.Google Scholar
  34. Lin, K. M., and Poland, R. E. 1984Variation in neuroleptic response: Asians vs. Caucasians. Presented at Annual Meeting of Society for Study of Psychiatry and Culture, Santa Fe, N. M., September 26–29.Google Scholar
  35. Linnoila, M., George, L., Guthrie, S., et al. 1981 Effect of alcohol consumption and cigarette smoking on antidepressant levels of depressed patients. American Journal of Psychiatry 138: 841–842.Google Scholar
  36. Livingston, R. L., Zucker, D. K., Isenberg, K., et al. 1983 Tricyclic antidepressants and delirium. Journal of Clinical Psychiatry 44: 173–176.Google Scholar
  37. Luscombe, D. K. 1977 Factors influencing plasma drug concentrations. Journal of Internal Medicine Research 5(suppl. 1): 82–97.Google Scholar
  38. Marcos, L. R. and Cancro, R. 1982 Pharmacotherapy of Hispanic depressed patients: clinical observations. American Journal of Psychotherapy 36: 505–512.Google Scholar
  39. McDonald, R. L., 1967 The effects of personality type on drug response. Archives of General Psychiatry 17: 680–686.Google Scholar
  40. Murphy, H. B. M. 1969 Ethnic variations in drug responses. Transcultural Psychiatric Research Review 6: 6–23.Google Scholar
  41. Murphy, H. B. M. 1974 Psycopharmacologie et Variations Ethnoculturelles. Confrontation Psychiatrique, 9: 163–185, 1972. Abstracted in English in Transcultural Psychiatric Research Review 11: 28–31.Google Scholar
  42. Murphy, H. B. M. 1982 Comparative Psychiatry: The International and Intercultural Distribution of Mental Illness. New York: Springer-Verlag.Google Scholar
  43. Okuma, T. 1981 Differential sensitivity to the effects of psychotropic drugs: psychotics vs. normals; Asians vs. Western populations. Folia Psychiatrica et Neurologica 35: 79–81.Google Scholar
  44. Olatawara, M. O. 1978 The effects of psychotropic drugs in different populations. Bulletin of the World Health Organization 56: 519–523.Google Scholar
  45. Pi, E. and Simpson, G. M. 1984Cross-Cultural Pharmacokinetics of Desipramine. Presented at Annual Meeting, American Psychiatric Association, Los Angeles, May 5–11.Google Scholar
  46. Potkin, S. G., Shen, Y., Pardes, H., et al. 1984 Haloperidol concentrations elevated in Chinese patients. Psychiatry Research 12: 167–172.Google Scholar
  47. Prince, R., (ed.) 1982Shamans and Endorphins. Ethos 10: 299–423.Google Scholar
  48. Rawlins, M. D. 1974 Variability in response to drugs. British Medical Journal 4: 91–94.Google Scholar
  49. Risch, S. C., Kalin, N. H., Janowsky, D. S., et al. 1981 Indications and guidelines for plasma tricyclic antidepressant concentration monitoring. Journal of Clinical Psychopharmacology 1: 59–63.Google Scholar
  50. Rudorfer, M. V. and Robins, E. 1982 Amitriptyline overdose: clinical effects on tricyclic antidepressant plasma levels. Journal of Clinical Psychiatry 43: 457–460.Google Scholar
  51. Rudorfer, M. V., Lan, E. A., Chang, W. H., et al. 1984 Desipramine pharmacokinetics in Chinese and Caucasian volunteers. British Journal of Clinical Pharmacology 17: 433–440.Google Scholar
  52. Sartorius, N. 1975 Epidemiology of depression. WHO Chronicle 29: 423–427.Google Scholar
  53. Sartorius, N. 1980 The research component of the WHO mental health programme. Psychological Medicine 10: 175–185.Google Scholar
  54. Sartorius, N. and Jablensky, A. 1978 Collaborating research for the development of guidelines for treatment and rehabilitation of depressed patients in developing countries, in Proceedings of Third World Congress of International Rehabilitation Association, Huber: Bern, Basle.Google Scholar
  55. Sarwer-Foner, G. J. 1960 Recognition and management of drug-induced extrapyramidal reactions and “paradoxical” behavioral reactions in psychiatry. Canadian Medical Association Journal 83: 312–318.Google Scholar
  56. Slater, P. E., and Kasterbaum, R. 1966 Paradoxical reactions to drugs: some personality and ethnic correlates. Journal of American Geriatric Society 14: 1016–1034.Google Scholar
  57. Spector, R., Choudhary, A. K., Chiang, C. K., et al. 1980 Diphenhydramine in Orientals and Caucasians. Clinical Pharmacology and Therapeutics 28: 229–234.Google Scholar
  58. Takahashi, R. 1979 Lithium treatment in affective discorders: therapeutic plasma level. Psychopharmacology Bulletin 15: 32–35.Google Scholar
  59. Tseng, W. S. and McDermott, J. F. 1981 Culture, Mind and Therapy: An Introduction to Cultural Psychiatry. New York: Brunner/Mazel.Google Scholar
  60. Vesell, E. S. 1974 Genetic factors affecting response to psychopharmacological agents. Psychopharmacology Bulletin 10: 68–69.Google Scholar
  61. Westermeyer, J. 1982 Poppies, Pipes, and People: Opium and Its Use in Laos. Berkeley: University of California Press.Google Scholar
  62. Whitford, G. M. 1978 Acetylator phenotype in relation to monoamine oxidase inhibitor antidepressant drug therapy. International Pharmacopsychiatry 31: 126–132.Google Scholar
  63. World Health Organization: 1979 Schizophrenia: An International Follow-up Study. Chichester: John Wiley & Sons.Google Scholar
  64. Wu, W. H., Lee, C. F., Yang, Y. Y., et al. 1983 Imipramine plasma levels and clinical response. Bulletin of Chinese Society of Neurology and Psychiatry 9: 40–49.Google Scholar
  65. Yamanoto, J., Fung, D., Lo., S., et al. 1979 Psychopharmacology for Asian Americans and Pacific Islanders. Psychopharmacology Bulletin 15: 29–31.Google Scholar
  66. Yamashita, I., and Asano, Y. 1979 Tricyclin antidepressants: therapeutic plasma level. Psychopharmacology Bulletin 15: 40–41.Google Scholar
  67. Yang, Y. Y. 1985 Prophylactic efficacy of lithium and its effective plasma levels in Chinese bipolar patients. Acta Psychiatrica Scandinavia 71: 171–175.Google Scholar
  68. Ziegler, V. E. and Biggs, J. T. 1977 Tricyclic plasma levels: effects of age, race, sex and smoking. JAMA 283: 2167–2169.Google Scholar

Copyright information

© D. Reidel Publishing Company 1986

Authors and Affiliations

  • Keh-Ming Lin
    • 1
  • Russell E. Poland
    • 1
  • Ira M. Lesser
    • 1
  1. 1.Department of PsychiatryHarbor-UCLA Medical CenterTorranceU.S.A.

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