Long‐term efficacy and therapeutic drug monitoring of sertraline in major depression

Abstract

Maintenance treatment for depression should be considered as a chronic disease management programme. Several studies have reported that sertraline (SRT) can be useful in preventing relapses and recurrent episodes of major depression.Twenty-three outpatients, 14 males and 9 females, affected by major depressive disorder, recurrent (DSM-IV criteria) were included. The patients were prescribed 25-150 mg of SRT for 12 months and were evaluated at baseline (T(0)), after 15 days (T(0.5)), 30 days (T(1)), 6 months (T(6)) and 12 months (T(12)) by using the brief psychiatric rating scale (BPRS), Hamilton rating scale for anxiety (HRS-A) and Hamilton rating scale for depression (HRS-D). Plasma samples for SRT level determination were collected at T(0.5), T(1), T(6) and T(12). There was a positive relationship between SRT oral dose and drug plasma levels. Lower plasma levels, 25-50 ng/ml, were adequate for clinical maintenance treatment. Our data suggest that SRT seems to be effective and well tolerated at low dosages both in the acute and maintenance treatment of recurrent depression. Monitoring the SRT plasma level, even though not strictly necessary from a clinical point of view, can be useful in optimizing treatment.

Addition of risperidone to sertraline improves sertraline‐resistant refractory depression without influencing plasma concentrations of sertraline and desmethylsertraline

“…Although the biological activity in desmethylsertraline does not seem to be associated with the clinical efficacy of sertraline, plasma desmethylsertraline level also did not differ between the responders (39.8 AE 7.1 ng/ml) and the nonresponders (44.8 AE 17.1 ng/ml). Some studies have found that therapeutic drug monitoring may be useful for dose optimization as serum concentrations of 25-50 ng/ml appear to be adequate for efficacy (Lundmark and Reis, 2000;Mauri et al, 2003). In contrast, Hong Ng et al (2006) have indicated no visible relationship between plasma sertraline levels and its clinical efficacy.…”

Grapefruit juice alters plasma sertraline levels after single ingestion of sertraline in healthy volunteers

“…Nonetheless, some studies have demonstrated that therapeutic drug monitoring may be useful for dose optimization, because a serum concentration of 25Á50 ng/ml appears to be adequate for efficacy (Lundmark et al 2000;Mauri et al 2003). Since grapefruit juice appears to increase blood sertraline levels, it is possible that grapefruit juice influences the efficacy and/or adverse effects of sertraline.…”

Pharmacokinetics of Antidepressants in Patients with Hepatic Impairment

“…The oral dosage should be adjusted in patients with hepatic impairment at a dose regimen of 50-100 mg/day. Plasma level determination can be an useful tool to adjust the oral dosage [61,62].…”