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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| Hauptverfasser: | , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
March 2022
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| In: |
International clinical psychopharmacology
Year: 2022, Jahrgang: 37, Heft: 2, Pages: 29-37 |
| ISSN: | 1473-5857 |
| DOI: | 10.1097/YIC.0000000000000386 |
| Online-Zugang: | 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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| Verfasserangaben: | 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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| 520 | |a 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. | ||
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