Plasma concentration of clomipramine and desmethylclomipramine and clinical response in depressed patients.
In the treatment of endogenous depression with tricyclic antidepressants, poor response has been reported to be associated with both high and low plasma levels of drug. To clarify any such relationship, plasma levels of clomipramine and its metabolite desmethylclomipramine have been compared with clinical response in endogenously depressed patients treated with 150 mg clomipramine nightly for up to six weeks. Although individuals varied considerably in the plasma drug levels attained, steady state was generally reached after two weeks, while desmethylclomipramine usually continued to accumulate in the plasma to higher levels than the parent compound. As measured by Hamilton rating scores, clinical response showed no correlation with plasma clomipramine concentrations, although poor response tended to be associated with low levels of drug and high levels of metabolite. The latter might explain why mean severity of depression and side effects appeared to increase between three and six weeks.
D000328:Adult; D000368:Aged; D002997:Clomipramine / Q000031:analogs & derivatives* / Q000097:blood* / Q000627:therapeutic use; D003863:Depression / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
D002997:Clomipramine