It is now understood that the ways psychotropic medications are metabolized may vary (sometimes considerably) among ethnic groups. When metabolism rates are reduced, the result can be significantly higher blood levels of medications with consequent increases in side effects and possible toxicity.
In contrast, accelerated metabolism of drugs can result in inadequate blood levels and ineffective treatment outcomes. Differences in pharmacokinetics (how the body affects drugs) do exist among ethnic groups. These factors can make the difference between success or failure in pharmacological treatment.
The impact of one’s ethnic affiliation and culture on beliefs about medical treatment is a significant factor that is often overlooked in psychopharmacology. Beyond the physiological differences in medication responses, there are numerous factors that reflect cultural beliefs regarding views of mental illnesses and medical treatment in general.
In many parts of the world, as is true in a multitude of subcultures in the United States, views about the causes of psychiatric symptoms and generally held beliefs about treatment may vary considerably.
In a now classic study (Lee, Wing, and Kong 1992) researchers evaluated Chinese patients’ responses to treatment with lithium. These subjects exhibited typical side effects from lithium; however, their overall responses to these side effects often were quite different from those usually seen in most patients treated in a Western culture.
For example, although Caucasians treated in the United States complain of side effects (such as polydipsia: the need to drink a lot of water, and polyuria: frequent urination), their Asian counterparts often felt positive about these effects, because they were seen as a sign that the medication was cleaning out their bodies by removing toxins.
Their view of potentially adverse effects was significantly influenced by their cultural context.
This example highlights the importance of learning about particular beliefs and concerns prior to treating those from different cultural backgrounds. Henderson (1995), for instance, has noted that Latinos and Asians often anticipate that medication responses will occur quickly.
Be Sensitive to the Differences
This is especially important to know, given the fact that many psychiatric medications require weeks before noticeable symptomatic improvement can be seen. For these reasons, it’s essential to spend time acquainting oneself with preconceived notions about medicines and medication responses.
Moreover, since there are many different ethnic and cultural groups in the United States, the clinician must always be sensitive to these differences and strive to learn as much as possible regarding the beliefs and attitudes of various groups.
Other factors related to cultural differences also must be evaluated, such as the frequency of alcohol use and smoking (which can have an impact on drug metabolism) in particular cultural groups; low-income groups often suffer from more general medical problems and thus may be taking more prescription drugs (setting the stage for potential drug-drug interactions).
Many impoverished individuals also suffer from malnutrition. Unfortunately, access to medical and psychological treatment may also be influenced by one’s socioeconomic status. This (situation) can be further complicated by lack of access to transportation or the high cost of transportation, financial limitations that have an impact on the ability to purchase medications, and a tendency to not seek out regular preventive medical services.
Finally, not infrequently, people of color and those with very limited financial resources are seen for briefer and less frequent medical appointments
In numerous settings, indigenous healing traditions may represent dominant views about health. Many patients are reluctant to talk openly about such treatments to those who do not belong to their cultural group because of understandable concerns that their practices may not be understood or may be dismissed.
Additionally, some healing practices may include the use of herbs, some of which may pose problems regarding drug-drug interactions. Cultural beliefs about treatment may also influence the issue of medication adherence.
Express a Willingness to Understand
If the clinician is insensitive to alternative beliefs regarding healing and psychological symptoms, not only may the current treatment be less than successful, but this may alienate patients to such a degree that they will be unlikely to seek out standard psychiatric treatment in the future.
Therefore, it is important to clearly communicate to patients that you are very interested in knowing as much as possible about their unique cultural beliefs and to express a willingness to understand.
In addition, it may be helpful to know about particular cultural experiences and metaphors that can be used to help explain medication effects. For example, in agrarian cultures, the idea that it is necessary to prepare the soil and plant seeds well ahead of the harvest can be used as a familiar metaphor to illustrate how many psychiatric medications must be used for several weeks before symptom relief is experienced.
*This article is based on Dr. Moore’s latest book “Handbook of Clinical Psychopharmacology for Therapists” published by New Harbinger Press and coauthored by John Preston, John O’Neal, and Mary Talaga.
Preston, J., O’Neal, J., Talaga, M., & Moore, B. A. (in press). Handbook of Clinical Psychopharmacology for Therapists-Ninth Edition. Oakland, CA: New Harbinger Press.