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Antidepressant efficacy is correlated with plasma levels: mega-analysis and further evidence

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 fi...

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Main Authors: Cellini, Lorenzo (Author) , De Donatis, Domenico (Author) , Zernig, Gerald (Author) , De Ronchi, Diana (Author) , Giupponi, Giancarlo (Author) , Serretti, Alessandro (Author) , Hart, Xenia Marlene (Author) , Conca, Andreas (Author) , Florio, Vincenzo (Author)
Format: Article (Journal)
Language:English
Published: March 2022
In: International clinical psychopharmacology
Year: 2022, Volume: 37, Issue: 2, Pages: 29-37
ISSN:1473-5857
DOI:10.1097/YIC.0000000000000386
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1097/YIC.0000000000000386
Verlag, kostenfrei, Volltext: http://journals.lww.com/intclinpsychopharm/fulltext/2022/03000/antidepressant_efficacy_is_correlated_with_plasma.1.aspx
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Author Notes:Lorenzo Cellini, Domenico De Donatis, Gerald Zernig, Diana De Ronchi, Giancarlo Giupponi, Alessandro Serretti, Hart Xenia, Andreas Conca and Vincenzo Florio
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Summary: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.
Item Description:Gesehen am 17.09.2024
Vor- und Nachname von Xenia Hart sind in der Verfasserangabe fälschlich vertauscht worden
Physical Description:Online Resource
ISSN:1473-5857
DOI:10.1097/YIC.0000000000000386

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