title: The AGNP-TDM Expert Group Consensus Guidelines: focus on therapeutic monitoring of antidepressants.
abstract: Therapeutic drug monitoring (TDM) of psychotropic drugs such as antidepressants has been widely introduced for optimization of pharmacotherapy in psychiatric patients. The interdisciplinary TDM group of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) has worked out consensus guidelines with the aim of providing psychiatrists and TDM laboratories with a tool to optimize the use of TDM. Five research-based levels of recommendation were defined with regard to routine monitoring of drug plasma concentrations: (i) strongly recommended; (ii) recommended; (iii) useful; (iv) probably useful; and (v) not recommended. In addition, a list of indications that justify the use of TDM is presented, eg, control of compliance, lack of clinical response or adverse effects at recommended doses, drug interactions, pharmacovigilance programs, presence of a genetic particularity concerning drug metabolism, and children, adolescents, and elderly patients. For some drugs, studies on therapeutic ranges are lacking, but target ranges for clinically relevant plasma concentrations are presented for most drugs, based on pharmacokinetic studies reported in the literature. For many antidepressants, a thorough analysis of the literature on studies dealing with the plasma concentration-clinical effectiveness relationship allowed inclusion of therapeutic ranges of plasma concentrations. In addition, recommendations are made with regard to the combination of pharmacogenetic (phenotyping or genotyping) tests with TDM. Finally, practical instructions are given for the laboratory practitioners and the treating physicians how to use TDM: preparation of TDM, drug analysis, reporting and interpretation of results, and adequate use of information for patient treatment TDM is a complex process that needs optimal interdisciplinary coordination of a procedure implicating patients, treating physicians, clinical pharmacologists, and clinical laboratory specialists. These consensus guidelines should be helpful for optimizing TDM of antidepressants.
authors.affiliation: Department of Psychiatry, University of Lausanne, Prilly Lausanne, Switzerland. pierre.baumann@chuv.ch
authors.forename: Pierre
authors.initials: P
authors.lastname: Baumann
authors.forename: Sven
authors.initials: S
authors.lastname: Ulrich
authors.forename: Gabriel
authors.initials: G
authors.lastname: Eckermann
authors.forename: Manfred
authors.initials: M
authors.lastname: Gerlach
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Kuss
authors.forename: Gerd
authors.initials: G
authors.lastname: Laux
authors.forename: Bruno
authors.initials: B
authors.lastname: Müller-Oerlinghausen
authors.forename: Marie Luise
authors.initials: ML
authors.lastname: Rao
authors.forename: Peter
authors.initials: P
authors.lastname: Riederer
authors.forename: Gerald
authors.initials: G
authors.lastname: Zernig
authors.forename: Christoph
authors.initials: C
authors.lastname: Hiemke
mesh_terms: D000928:Antidepressive Agents / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans
chemical_list: D000928:Antidepressive Agents