Therapeutic drug monitoring of selective serotonin reuptake inhibitors influences clinical dosing strategies and reduces drug costs in depressed elderly patients

• Published in: Acta psychiatrica Scandinavica Vol. 101; no. 5; pp. 354 - 359
• Main Authors: Lundmark, J., Bengtsson, F., Nordin, C., Reis, M., Wålinder, J.
• Format: Journal Article
• Language: English
• Published: Copenhagen Munksgaard International Publishers 01.05.2000; Blackwell
• Subjects: Aged; Aged, 80 and over; antidepressants; Biological and medical sciences; depression; Depression - drug therapy; Depression - economics; Dose-Response Relationship, Drug; Drug Monitoring - economics; Female; Humans; Male; Medical sciences; MEDICIN; MEDICINE; Neuropharmacology; pharmaceutical economics; pharmacokinetics; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Retrospective Studies; serotonin uptake inhibitors; Serotonin Uptake Inhibitors - economics; Serotonin Uptake Inhibitors - therapeutic use; Treatment Outcome; Sweden; Europe; Human; Mood disorder; Social environment; Serotonin; Decision making; Psychotropic; Treatment efficiency; Mental health; Depression; Reuptake inhibitor; Dose activity relation; Therapeutic drug monitoring; Chemotherapy; Treatment; Follow up study; Medical prescription; Health economy; Antidepressant agent; Strategy; Clinical investigation; Cost analysis; Elderly; Comparative study; Public health
• ISSN: 0001-690X; 1600-0447; 1600-0447
• DOI: 10.1034/j.1600-0447.2000.101005354.x

Objective: This study was initiated in order to describe and evaluate the effects of a therapeutic drug monitoring (TDM) routine of selective serotonin reuptake inhibitors (SSRIs) on treatment strategies and drug costs in depressed elderly patients. Method: Blood samples were drawn from elderly depressed patients and analysed for steady‐state trough serum concentrations of citalopram (n=48), paroxetine (n=48) or sertraline (n=39). A global efficacy evaluation was made at baseline and after 6–9 months. Antidepressant drug costs before and after TDM were estimated. Results: Eight samples were excluded due to technical problems or non‐compliance. In 65 of the 127 (51.2%) remaining cases, the treatment strategy was changed according to the TDM outcome, in most a reduction of the prescribed dose. Bioanalytical TDM costs included the antidepressant drug costs after TDM were reduced by 10.2%. Conclusion: The results support the utility of TDM in the search for the individual minimum effective SSRI dose in the elderly.