Racial and Ethnic Considerations for the Clinical Practice of Psychopharmacology and Research Methodology: A Narrative Review of the Growing Body of Literature

BACKGROUND: Race and ethnicity are important but often underexamined factors in psychopharmacology research and clinical practice. This review summarizes key findings on ethnic and racial considerations for researchers, medical practitioners, and clinical psychopharmacologists. We hope it serves an important function in highlighting a critically important, yet still emerging issue to inform research and therapeutic use of psychotropics to improve their effectiveness. METHODS: We queried major databases (PubMed, PsycInfo, Embase) using a search strategy that included MeSH (Medical Subject Headings) terms and conducted a snowball search to identify studies addressing ethnic or racial aspects of psychopharmacological practice. Findings were synthesized and presented in clinically applicable areas. RESULTS: The clinically relevant ethnic and racial considerations identified in this review can be broadly categorized into the following areas: (1) variations in therapeutic and adverse dose-responses (eg, non-Whites attaining therapeutic and adverse effects at lower doses with certain medications); (2) interracial differences in prescription patterns of psychotropics, with lower prescription rates among under-represented minority groups and greater use of first-generation antipsychotics in African American populations; and (3) variations in attitudes toward psychopharmacotherapy. While differences in medication response can be partially explained by genetic variations in metabolism or receptor sensitivity, systemic racism and social determinants of health continue to have an influence. CONCLUSIONS: The evidence base for ethnic and racial considerations in psychopharmacology research and clinical practice continues to evolve with growing consideration for diversity and inclusivity in training, research, and clinical practice. This is critical to promoting equitable and effective care to a diverse population. Key questions are highlighted to draw attention to these critical needs.