Western practitioners already know that "a general rule of thumb" is that they have to lower meds dosages for people of East Asian descent, although a book I read on Culture-Bound Syndromes felt that this was too deeply entrenched in Western culture as a stereotype.

I would also disagree that depression is "on the rise" in East Asia. If you look at psychiatric syndromes world-wide, almost all diseases fall into a very few psychiatric 'taxa'--depressive disorders, anxiety disorders, dissociative disorders, psychotic disorders, etc. So while the actual diagnosis of depression may be on the rise in Asia, the prevalence of syndromes such as shenjian shuairuo in China or shin-byung in Korea has probably not changed all that much.

For me, the question is whether or not diagnosing as depression rather than shenjian shuairuo or whatever will actually have good effects. For example, a (western) psychiatrist working in Thailand had much better results when he accepted the Thai culture-bound diagnoses and traditional Thai healing models instead of trying to force it into a DSM model and psychotropic-it away.

It sickens me the way DSM treats culture-bound syndromes--a great deal of the rest of the world considers Dissociative Identity Disorder and Anorexia Nervosa to be American culturally-bound syndromes belonging to the psychiatric taxa of dissociative disorders, which appear in slightly different forms in almost every culture, and somatic/anxiety disorders, which also appear in every culture. Yet DSM legitimates our CBSs and relegates those of other culturals to some second-tier semi-legitimate oh-aren't-the-natives-quaint diagnosis.

Little rant off topic.

You make a lot of good points here, most of which I am very ill-equipped to talk about.

Regarding the validity of the "higher rate" of depression in East Asia, I would certainly agree that increased diagnosis accounts for some (much?) of it. However, the article does cite increased suicide rates as additional evidence for a higher rate of depression in China--rather, it claims that there is an increase; it supplies no data or references to support this. This is somewhat better evidence, though it could still be invalid --for one thing, it could merely reflect a change in record-keeping. A similar case can be seen with cancer in black males over the past hundred years; looking at autopsy reports, there is an apparent rise in cancer-related deaths in recent years because, previously, families had requested that "cancer" not be listed as the cause of death due to social stigma.

Back to the pharmacogenetics, with which I am much more comfortable. In this case, the patients who stand to benefit from pharmacogenetics in the short run are the minority group of normal metabolizers who are treated (initially, at least) as if they were poor metabolizers. The benefits to the poor metabolizers would come from future studies--large-scale pharmacogenetic screens to identify all of the genetic factors involved in drug metabolism, design of new drugs to circumvent these problems if possible, etc. Unfortunately, this all presupposes that we're living in some sort of happy world in which pharmacogenetics is in the clinic, which, except for a handful of cases (TPMT testing at the Mayo Clinic being one of the more famous ones) is quite untrue.