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Refugees have been demonstrated to be at high risk for developing major depressive and posttraumatic stress disorders, but are often not able to benefit from modern advances in psychopharmacology. Besides difficulties in cross-cultural psychiatric diagnosis, problems also arise from cultural differences in the expectation of drug effects and in compliance. Recent evidence has suggested that pharmacokinetic and pharmacodynamic profiles of various psychotropic medications may be different in Asians than in non-Asian patients, leading to differences in dosage requirements and side effect profiles. These issues and their relevance to the care of refugee patients are reviewed.