title: Prediction of antidepressant response to venlafaxine by a combination of early response assessment and therapeutic drug monitoring.
abstract: BACKGROUND
  Early assessment of a therapeutic response is a central goal in antidepressant treatment. The present study examined the potential for therapeutic drug monitoring and symptom rating to predict venlafaxine treatment efficacy (measured by overall patient response and remission).
  
  
  METHODS
  88 patients were uptitrated homogenously to 225 mg/day venlafaxine. Serum concentrations of venlafaxine (VEN) and its active metabolite O-desmethylvenlafaxine (ODV) were measured at week 2. Continuous psychopathometric ratings were measured for up to 6 weeks by independent study raters.
  
  
  RESULTS
  An early improvement was significantly more common in venlafaxine responders than non-responders (χ(2); p=0.007). While ODV serum levels were significantly higher in responders (t test; p=0.006), VEN serum levels, sum level of VEN+ODV and the ratio of ODV/VEN levels were not. Moreover, patients who showed an early response combined with an ODV serum level above the median of 222 ng/mL were significantly more likely to achieve full response (binary logistic model; p<0.01). Sensitivity (84% for early response) and specificity (81% for combination of early response and therapeutic drug monitoring) were sufficient to qualify as a reasonable screening instrument.
  
  
  CONCLUSIONS
  Our results indicate that early improvement and ODV serum concentration are predictive of therapeutic outcome and can thus be used to guide use of the antidepressant venlafaxine.
authors: Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
authors: T J
authors: TJ
authors: Stamm
authors: Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
authors: D
authors: D
authors: Becker
authors: Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
authors: L M
authors: LM
authors: Sondergeld
authors: Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
authors: K
authors: K
authors: Wiethoff
authors: Department of Psychiatry and Psychotherapy, Universitätsmedizin Mainz, Germany.
authors: C
authors: C
authors: Hiemke
authors: School of Psychology, University College Dublin, Ireland.
authors: G
authors: G
authors: O'Malley
authors: Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
authors: R
authors: R
authors: Ricken
authors: Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: M
authors: M
authors: Bauer
authors: Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
authors: M
authors: M
authors: Adli
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D000069468:Desvenlafaxine Succinate / Q000097:blood / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use*
chemical_list: D000928:Antidepressive Agents; D000069470:Venlafaxine Hydrochloride; D000069468:Desvenlafaxine Succinate