Therapeutic drug monitoring (TDM) of serotonergic antidepressants in anxiety and obsessive-compulsive disorders

Introduction: The efficacy of serotonergic antidepressants – SSRI, SNRI and clomipramine – in anxiety and obsessive-compulsive disorders has been sufficiently proven. In guidelines, they are regarded as substances of first choice. In addition, there is the recommendation to use higher doses than for patients with affective disorders. But in contrast to depressive disorders the corresponding plasma levels are not yet explored [1]. Method: Patients of both sexes with a confirmed diagnosis of anxiety (ICD-10: F40.x, F41.0, F41.1) or obsessive compulsive disorder (ICD-10: F42.x) who were treated under natural conditions in an academic state hospital were included. The choice of antidepressant was made according to clinical criteria, based on the WFSBP guidelines. Enclosed patients were treated with paroxetine, sertraline, citalopram/escitalopram or venlafaxine. For TDM, blood was collected under steady state conditions, after two and four weeks and at discharge. At the same time points, the Clinical Global Impression (CGI) scale, part 1 and 2, Hamilton Anxiety Scale (HAMA) and Self-Rating Anxiety Scale (SAS) were documented in the case of anxiety disorders and Yale Brown Obsessive-Compulsive Scale (Y-BOCS) in the case of obsessive-compulsive disorders. The tolerability and side effects were operationalized by the UKU-scale. Results: Included were 26 patients, 24 and 2 patients had the diagnosis of anxiety and of obsessive-compulsive disorder, respectively. The results (TDM, clinical) will be presented and discussed. References: Hiemke C, Baumann P, Bergemann N et al. AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Psychiatry: Update 2011. Pharmacopsychiatry 2011; 44: 195–235