Pharmacopsychiatry 2005; 38 - 42
DOI: 10.1055/s-2005-862655

The German Network on Depression: TDM of New and Old Antidepressant Drugs

C Hiemke 1, HJ Kuss 3, MJ Müller 1, ML Rao 2, A Dragicevic 1, M Fric 5, E Geiger 5, K Grasmäder 2, S Härtter 1, G Laux 5, J Röschke 4, J Sachse 1, B Schanz 1, A Scherer 5
  • 1Psychiatric Hospital of the University of Mainz, Germany
  • 2Psychiatric Hospital of the University of Bonn, Germany
  • 3Psychiatric Hospital of the University of Munich, Germany
  • 4Psychiatric Hospital Kiedrich/Rheingau, Germany
  • 5Psychiatric Hospital Wasserburg/Inn, Germany

Few studies have shown that therapeutic drug monitoring (TDM) may have medical and economic benefits when treating depressed patients. Reports on effects of TDM under naturalistic clinical conditions, however, are lacking. In this naturalistic multicenter study which was a subproject of the competence network on depression we investigated a TDM group and a randomly assigned parallel group without TDM while on antidepressant drug treatment.

219 patients (103 with TDM) who were treated with citalopram (29.2%), sertraline (20.1%), venlafaxine (14.6%), amitriptyline (12.3%) or other new (6.0%) or old (9.2%) antidepressant drugs were included. On day 0, their mean Hamilton Depression Rating Scale (HAMD-17) score was 23.3±6.6 without significant differences between the two groups. Without TDM, treatment discontinuation (n=39, 16.7%) and changes of antidepressant medication (n=13, 3.2%) were two times more often than in the group with TDM (20 and 7, respectively). Patients with TDM stayed 8.7 days shorter in the hospital than patients without TDM (mean 53.9 and 62.6 days, respectively) which was not statistically significant. Direct effects of TDM were not found. Moreover, many patients were not titrated to recommended therapeutic blood levels. In a subgroup of patients who were treated with venlafaxine and where most patients were dosed to therapeutic blood levels by TDM, it was found that TDM accelerated the improvement. Moreover, it was found that nonimprovement at week 2 indicated by a <20% decrease in the HAMD-17 score was predictive for nonresponse (<50% decrease of HAMD-17 score) at week 5. Of the patients who did not improve during the first 2 weeks, only 15% responded to the treatment in the later phase.

In conclusion, TDM may have a medical and economic impact. The „compliance“ of psychiatrists in charge to recommendations provided together with serum levels, however, was far from perfect. Evidence is given that combining TDM and clinical judgement by objective symptom rating can provide a superior outcome.

This research work was a subproject of the competence network „Depression/Suicidality“) supported by a grant of the BMBF, Germany