Antidepressant efficacy is correlated with plasma levels: mega-analysis and further evidence.
Int Clin Psychopharmacol
; 37(2): 29-37, 2022 03 01.
Article
in En
| MEDLINE
| ID: mdl-34908537
ABSTRACT
The debate around optimal target dose for first-line antidepressants (ADs) is still ongoing. Along this line, therapeutic drug monitoring (TDM) represents one of the most promising tools to improve clinical outcome. Nevertheless, a few data exist regarding the concentration-effect relationship of first-line ADs which limits TDM implementation in routine clinical practice. We conducted the first patient-level concentration-response mega-analysis including data acquired by us previously and explored the concentration dependency of first-line AD (206 subjects). Further, new data on mirtazapine are reported (18 subjects). Hamilton Depression Rating Scale-21 administered at baseline, at month 1 and month 3 was used as the measure of efficacy to assess antidepressant response (AR). When pooling all four first-line ADs together, normalized plasma levels and AR significantly fit a bell-shaped quadratic function with a progressive increase of AR up to around the upper normalized limit of the therapeutic reference range with a decrease of AR at higher serum levels. Our results complement the available evidence on the issue and the recent insights gained from dose-response studies. A concentration-dependent clinical efficacy, such as previously demonstrated for tricyclic compounds, also emerge for first-line ADs. Our study supports a role for TDM as a tool to optimize AD treatment to obtain maximum benefit.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Drug Monitoring
/
Antidepressive Agents
Limits:
Humans
Language:
En
Journal:
Int Clin Psychopharmacol
Journal subject:
PSICOFARMACOLOGIA
Year:
2022
Document type:
Article