Linking Genome-Wide Association Studies to Pharmacological Treatments for Psychiatric Disorders Arnatkeviciute 2025

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2827732

Key Points

Question Do genes targeted by current treatments for psychiatric disorders match genetic variation identified through genome-wide association studies (GWAS), and what bioinformatic data modalities can inform these relationships?

Findings In this multimodal bioinformatic study investigating links between GWAS-identified genetic variation and treatment targets, information derived from functional data in the form of a protein-protein interaction network revealed links for bipolar disorder; however, for most psychiatric disorders, the correspondence between GWAS-implicated genes and treatment targets did not exceed null expectations.

Meaning Results suggest that GWAS-identified genetic variation driving the risk for psychiatric disorders may be distinct from the pathophysiological mechanisms influencing symptom onset and severity that are targeted by pharmacological treatments.

Abstract
Importance Large-scale genome-wide association studies (GWAS) should ideally inform the development of pharmacological treatments, but whether GWAS-identified mechanisms of disease liability correspond to the pathophysiological processes targeted by current pharmacological treatments is unclear.

Objective To investigate whether functional information from a range of open bioinformatics datasets can elucidate the relationship between GWAS-identified genetic variation and the genes targeted by current treatments for psychiatric disorders.

Design, Setting, and Participants Associations between GWAS-identified genetic variation and pharmacological treatment targets were investigated across 4 psychiatric disorders—attention-deficit/hyperactivity disorder, bipolar disorder, schizophrenia, and major depressive disorder. Using a candidate set of 2232 genes listed as targets for all approved treatments in the DrugBank database, each gene was independently assigned 2 scores for each disorder—one based on its involvement as a treatment target and the other based on the mapping between GWAS-implicated single-nucleotide variants (SNVs) and genes according to 1 of 4 bioinformatic data modalities: SNV position, gene distance on the protein-protein interaction (PPI) network, brain expression quantitative trail locus (eQTL), and gene expression patterns across the brain. Study data were analyzed from November 2023 to September 2024.

Main Outcomes and Measures Gene scores for pharmacological treatments and GWAS-implicated genes were compared using a measure of weighted similarity applying a stringent null hypothesis–testing framework that quantified the specificity of the match by comparing identified associations for a particular disorder with a randomly selected set of treatments.

Results Incorporating information derived from functional bioinformatics data in the form of a PPI network revealed links for bipolar disorder (P permutation [P-perm] = 7 × 10−4; weighted similarity score, empirical [ρ-emp] = 0.1347; mean [SD] weighted similarity score, random [ρ-rand] = 0.0704 [0.0163]); however, the overall correspondence between treatment targets and GWAS-implicated genes in psychiatric disorders rarely exceeded null expectations. Exploratory analysis assessing the overlap between the GWAS-identified genetic architecture and treatment targets across disorders identified that most disorder pairs and mapping methods did not show a significant correspondence.

Conclusions and Relevance In this bioinformatic study, the relatively low degree of correspondence across modalities suggests that the genetic architecture driving the risk for psychiatric disorders may be distinct from the pathophysiological mechanisms currently used for targeting symptom manifestations through pharmacological treatments. Novel approaches incorporating insights derived from GWAS based on refined phenotypes including treatment response may assist in mapping disorder risk genes to pharmacological treatments in the long term.

 

I wonder how this would look for treatments for ‘somatic’ issues. If they have a much higher correspondence, it could indicate that the current pharmopsychiatric approach has a habit of speculation rather than attempts at confimation.

 

This seems expected, and just about the wrong conclusions to take from it. We don't know what psychiatric illnesses are or what causes them, so any medications that are used should not be expected to target those causes. Even when the pathophysiology is well understood, it's difficult to develop drugs that will effectively target them in a therapeutic way.

The main conclusion should be that whatever models were developed based on those treatments, or other hypotheses, aren't of much use beyond the fact that they take into account drugs that are used to try to treat the underlying illnesses. Same as most attempts at trying to figure out the problem with serotonin in depression hasn't been of much help, even though complex models and narratives were developed out of it anyway.

It's not as if the notion of psychiatric disorders has a reliable definition anyway. If it just means 'affecting behavior', which is the original definition, there are so many illnesses with no direct effect on the brain that still very much change behavior.

It would really help psychiatry move along if they didn't just accept that they still don't know much half the time, and made up models based on the idea of already having perfect knowledge of medicine in the other half. It's barely in its infancy yet, we're just getting started having the tools to go beyond superficial observation.