Antidepressant Therapeutic Drug Monitoring by Minimally Invasive Techniques in Eating Disorders Patients: Preliminary Results from a Pilot Study with Focus on Vortioxetine

Abstract

Therapeutic Drug Monitoring (TDM) is an evidence-based practice consistent with the assumption that pharmacological plasmatic concentrations correlate better with clinical effects than prescribed doses of the used drugs. TDM has several indications in treated psychiatry patients: comorbidities, suspected non-compliance, severe adverse effects and tailored pharmacotherapy. Antidepressant Drugs (AD) are prescribed in patients with Eating Disorders (ED) to treat depression or anxiety disorders associated with ED or to reduce binge-eating behaviours. TDM may represent a valid tool in this population, considering the limited efficacy of ED's pharmacological treatment and the high rate of adverse effects. Nineteen outpatients affected by ED with a Body Mass Index (BMI) < 20 or > 30 kg/m 2 treated with antidepressants agreed to participate in this study. Participants were treated with Sertraline (N=5), Fluoxetine (N=6), Vortioxetine (N=4), Citalopram (N=2), Escitalopram (N=1), Fluvoxamine (N=1). Oral fluid samples and whole blood dried microsamples by finger puncture using VAMS (Volumetric Absorptive Microsampling) technique were obtained from patients. Sociodemographic and clinical information were also collected.Preliminary results by our pilot study show a correlation between plasmatic and salivary concentrations only for Vortioxetine but not for other examined antidepressants. Additionally, plasmatic concentrations of all examined antidepressants are constant for extreme BMI when dose-corrected. By considering these preliminary data, we are confident that further studies characterized by the expansion of the sample size will allow us to outline that TDM may represent a valid tool in order to better explain the limited efficacy of AD in patients with starvation state or obesity.