Therapeutic monitoring of psychoactive drugs - antidepressants: A review

Grundmann, Milan; Kacířová, Ivana; Urinovska, R.

doi:10.5507/bp.2013.020

Cited by 18 publications

(11 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Commonly used classes of antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and serotonin antagonists and reuptake inhibitors (SARIs). The first generation of antidepressants -tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are still occasionally used 19 . Based on the "monoamine theory" of depression, the mechanism of action of these antidepressants is to increase the synaptic availability of the neurotransmitters 20 .…”

Section: Treatment Of Depression and Anxiety Disordersmentioning

confidence: 99%

The role of cytochromes P450 in the metabolism of selected antidepressants and anxiolytics under psychological stress

Zemanová¹,

Anzenbacher²,

Anzenbacherová³

2022

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

In today's modern society, it seems to be more and more challenging to cope with life stresses. The effect of psychological stress on emotional and physical health can be devastating, and increased stress is associated with increased rates of heart attack, hypertension, obesity, addiction, anxiety and depression. This review focuses on the possibility of an influence of psychological stress on the metabolism of selected antidepressants (TCAs, SSRIs, SNRIs, SARIs, NDRIs a MMAs) and anxiolytics (benzodiazepines and azapirone), as patients treated with antidepressants and/or anxiolytics can still suffer from psychological stress. Emphasis is placed on the drug metabolism mediated by the enzymes of Phase I, typically cytochromes P450 (CYPs), which are the major enzymes involved in drug metabolism, as the majority of psychoactive substances are metabolized by numerous CYPs (such as CYP1A2, CYP2B6, CYP2C19, CYP2C9, CYP2A6, CYP2D6, CYP3A4). As the data on the effect of stress on human enzymes are extremely rare, modulation of the efficacy and even regulation of the biotransformation pathways of drugs by psychological stress can be expected to play a significant role, as there is increasing evidence that stress can alter drug metabolism, hence there is a risk of less effective drug metabolism and increased side effects.

show abstract

Section: Treatment Of Depression and Anxiety Disordersmentioning

confidence: 99%

The role of cytochromes P450 in the metabolism of selected antidepressants and anxiolytics under psychological stress

Zemanová¹,

Anzenbacher²,

Anzenbacherová³

2022

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

show abstract

“…In everyday clinical practice, TDM regards drugs that are commonly used in clinical practice, satisfying the criteria for implementation of monitoring of their concentrations in blood, as specified above. They are listed in Table 2 [31,55,[58][59][60][61][62][63][64][65][66][67].…”

Section: Therapeutic Drug Monitoring-basic Assumptions and Rulesmentioning

confidence: 99%

“…Table 2. The examples of drugs subjected to the TDM procedure [31,55,[58][59][60][61][62][63][64][65][66][67].…”

Section: Therapeutic Drug Monitoring-basic Assumptions and Rulesmentioning

confidence: 99%

“…Table 2 presents the group of medications with the highest level of recommendation for TDM. In addition, it should be mentioned that in the case of many other drugs, especially in the field of neuro-psychopharmacology (e.g., aripiprazole, flupenthixol, quetiapine, duloxetine, fluoxetine, fluvoxamine, mirtazapine, paroxetine, sertraline, trazodone, venlafaxine), the TDM procedure also seems to be recommended [64][65][66][67]. Therefore, it can be concluded that the drug list for TDM has been progressively updated.…”

Section: Class Of the Drugs Examplesmentioning

confidence: 99%

See 1 more Smart Citation

Chronopharmacology in Therapeutic Drug Monitoring—Dependencies between the Rhythmics of Pharmacokinetic Processes and Drug Concentration in Blood

Dobrek

2021

Pharmaceutics

View full text Add to dashboard Cite

The objective of the optimization of pharmacotherapy compliant with the basic rules of clinical pharmacology is its maximum individualization, ensuring paramount effectiveness and security of the patient’s therapy. Thus, multiple factors that are decisive in terms of uniqueness of treatment of the given patient must be taken into consideration, including, but not limited to, the patient’s age, sex, concomitant diseases, special physiological conditions (e.g., pregnancy, lactation, extreme age groups), polypharmacotherapy and polypragmasia (particularly related to increased risk of drug interactions), and patient’s phenotypic response to the administered drug with possible genotyping. Conducting therapy while monitoring the concentration of certain drugs in blood (Therapeutic Drug Monitoring; TDM procedure) is also one of the factors enabling treatment individualization. Furthermore, another material, and yet still a marginalized pharmacotherapeutic factor, is chronopharmacology, which indirectly determines the values of drug concentrations evaluated in the TDM procedure. This paper is a brief overview of chronopharmacology, especially chronopharmacokinetics, and its connection with the clinical interpretation of the meaning of the drug concentrations determined in the TDM procedure.

show abstract

“…One aspect that has been highlighted in antidepressant research is a substantial pharmacokinetic variability of antidepressant medications. For several substances, concentrations in blood have been shown to vary more than 20-fold between individuals ( 7 ). Therapeutic drug monitoring (TDM), as a tool of precision medicine, considers this variability by measuring drug concentrations in blood (serum or plasma) and thus provides guidance for individualized dosing strategies.…”

Section: Introductionmentioning

confidence: 99%

Is Therapeutic Drug Monitoring Relevant for Antidepressant Drug Therapy? Implications From a Systematic Review and Meta-Analysis With Focus on Moderating Factors

et al. 2022

View full text Add to dashboard Cite

Inter-individual differences in antidepressant drug concentrations attained in blood may limit the efficacy of pharmacological treatment of depressive disorders. Therapeutic drug monitoring (TDM) enables to determine drug concentrations in blood and adjust antidepressant dosage accordingly. However, research on the underlying assumption of TDM, association between concentration and clinical effect, has yielded ambiguous results for antidepressants. It has been proposed that this ambiguity may be caused by methodological shortcomings in studies investigating the concentration-effect relationship. Guidelines recommend the use of TDM in antidepressant treatment as expert opinion. This reflects the lack of research, particularly systematic reviews and meta-analyses of randomized controlled trials, on the relationship between concentration and effect as well as on the benefits of the use of TDM in clinical practice. In this study, a systematic review and meta-analysis of randomized controlled trials has been performed to investigate the relationship between antidepressant concentration, efficacy, and side effects. It is the first meta-analytical approach to this subject and additionally considers methodological properties of primary studies as moderators of effect in quantitative analysis. Our results identified methodological shortcomings, namely the use of a flexible dose design and the exclusion of concentrations in lower- or subtherapeutic ranges, which significantly moderate the relationship between antidepressant concentration and efficacy. Such shortcomings obscure the evidence base of using TDM in clinical practice to guide antidepressant drug therapy. Further research should consider these findings to determine the relationship between concentration and efficacy and safety of antidepressant treatments, especially for newer antidepressants.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=246149, identifier: CRD42021246149.

show abstract

Therapeutic monitoring of psychoactive drugs - antidepressants: A review

Cited by 18 publications

References 54 publications

The role of cytochromes P450 in the metabolism of selected antidepressants and anxiolytics under psychological stress

The role of cytochromes P450 in the metabolism of selected antidepressants and anxiolytics under psychological stress

Chronopharmacology in Therapeutic Drug Monitoring—Dependencies between the Rhythmics of Pharmacokinetic Processes and Drug Concentration in Blood

Is Therapeutic Drug Monitoring Relevant for Antidepressant Drug Therapy? Implications From a Systematic Review and Meta-Analysis With Focus on Moderating Factors

Contact Info

Product

Resources

About