Stratified medicine in psychiatry: a worrying example or new opportunity in the treatment of anxiety?

Stratified medicine is a new term that figures highly in current MRC and NHS strategy. It has developed from the earlier terms individualised or personalised medicine and refers to the use of genetic and/or endophenotypic measures to allow better targeting of treatments. The best exemplar is HER2 positivity in breast cancer to determine the efficacy of Herceptin. Clinical trials of this anti-cancer drug were initially unpromising, but once the HER2 positive subgroup was identified it was found, in this subgroup only, to be highly effective. It is presumed that similar subgroups will be found for many common disorders not just cancers, and that these will lead to much better targeted treatments. Such an advance may be necessary to develop new treatments in certain fields where the development of broad-spectrum/blockbuster treatments appears to have reached the end of the road; a particular example of this is in psychiatry. In this paper we discuss this issue in relation to psychiatry using a new and interesting example of how genotyping might help rescue an apparently failed novel treatment in anxiety disorders.