Recent research and clinical experience has shown that African Americans may be at greater risk for inappropriate treatment. Such experiences can interact negatively with an existing distrust of the mental health system. Providers may show different prescribing patterns with racial and ethnic minorities: they may overuse antipsychotics, dispense higher dosages, and more commonly give involuntary treatment, which results in more side effects and a poorer outcome. Conversely, they may underuse other psychotropic medications, especially for anxiety and affective disorders, which are underdiagnosed in minorities. Recent research suggests that ethnic differences may exist in pharmacokinetics, and so different dosing strategies may be necessary. Not surprisingly African Americans in distress are more likely to seek initial treatment outside of the mental health system, seek treatment later in the course of the illness, complain more about side effects, and terminate treatment earlier. Cultural as well as socioeconomic factors must be considered. Newer pharmacological agents may be potentially more helpful for minorities because they are better tolerated, have better side effect profiles, and demonstrate better efficacy. However, African Americans have limited access to these agents. Education of providers and patients, policy changes in the public sector, wider implementation of research policies concerning inclusion of minorities, and different marketing strategies by pharmaceutical concerns are probably necessary to maximize pharmacotherapy of minorities.