Current Treatment Options in Psychiatry

, Volume 5, Issue 1, pp 17–29 | Cite as

Epigenetic Alterations Impact on Antipsychotic Treatment in Elderly Patients

  • Bryan M. McClarty
  • Daniel W. Fisher
  • Hongxin Dong
Schizophrenia and Other Psychotic Disorders (J Csernansky, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Schizophrenia and Other Psychotic Disorders


Purpose of the review

Antipsychotics are commonly prescribed for the treatment of psychosis as well as behavioral and psychological symptoms of dementia (BPSD) in elderly patients. However, elderly patients often experience decreased antipsychotic efficacy and increased side effects, though the mechanisms underlying these changes with age are not clear.

Recent findings

Although aging can affect drug metabolism and clearance through changes in renal and hepatic function, additional pharmacokinetic and pharmacodynamic changes due to aging-induced epigenetic alterations also impact processes important for antipsychotic function. Epigenetic mechanisms account for some of the altered efficacy and increased side effects seen in elderly patients.


Both clinical and animal studies from our group and others have demonstrated a plausible epigenetic mechanism involving histone modifications that can adversely affect the efficacy of antipsychotics and increase their side effects in elderly patients. Hopefully, further investigation of this mechanism will benefit elderly patients who need treatment for psychosis and BPSD.


Epigenetics Histone modification Antipsychotics Aging Drug efficacy Side effects 


Funding information

This work was supported by the National Institute of Mental Health (R21 MH100919-01A1, 5R01 MH109466-2) to Hongxin Dong and 5F30MH109249-02 to Daniel W. Fisher.

Compliance with Ethical Standards

Conflict of Interest

Bryan M. McClarty declares that he has no conflict of interest.

Daniel W. Fisher declares that he has no conflict of interest.

Hongxin Dong declares that she has no conflict of interest.

Human and animal Rights in Informed Consent

In this review papers, the cited articles contain studies with human and animal work approved by institutional review boards before publication.

References and Recommended Reading

Papers of particular interest, published recently,have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Bryan M. McClarty
    • 1
  • Daniel W. Fisher
    • 2
  • Hongxin Dong
    • 1
  1. 1.Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoUSA

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