Measurement of Serum Drug Levels in the Assessment of Antidepressants

Montgomery, Stuart

doi:10.1007/978-1-349-06038-2_5

Cited by 8 publications

(11 citation statements)

References 37 publications

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“…In this study we did not find a significant relationship between plasma concentrations of nomifensine and clinical response. This is in accord with the earlier study (Montgomery, 1980) which also did not find a significant relationship. The findings from other investigations of nomifensine are in accord and it therefore seems likely that a relationship between response and plasma concentrations such as is seen with nortriptyline does not exist with nomifensine.…”

Section: Discussionsupporting

confidence: 93%

“…This may be taken as evidence of some neuronal effect and an explanation in terms of receptor sensitivity has been suggested (Montgomery 1980). In this study, which investigated the full dose of 150mg of nomifensine, the reversal of effect is not seen.…”

Section: Discussionmentioning

confidence: 61%

“…There is less agreement concerning the relationship with amitriptyline, with some investigators finding no relationship, others a positive correlation between response and levels, and others a curvilinear relationship. Where an association has been found between poorer response and high plasma concentrations it appears to be the levels of the metabolite nortriptyline which are associated with a poorer response (Montgomery, 1980).…”

Section: Discussionmentioning

confidence: 99%

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Plasma levels and clinical response with imipramine in a study comparing efficacy with mianserin and nomifensine.

Montgomery¹,

Roy²,

Wynne‐Willson³

et al. 1983

Brit J Clinical Pharma

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1 The comparative antidepressant efficacy of 150 mg imipramine, 60 mg mianserin and 150 mg nomifensine was studied in 45 depressed patients in a six week double‐blind investigation. 2 In the efficacy analysis of 41 patients completing the study there was no overall significant difference in efficacy between the groups. Individual group comparisons showed no significant difference in response between mianserin and nomifensine, and mianserin and imipramine. There was a significant (z = 1.99, P less than 0.05) improved response in the imipramine compared with the nomifensine treated group. The imipramine treated group were significantly older. 3 No significant plasma concentration/clinical response relationships were demonstrated with nomifensine, mianserin, imipramine or desipramine. 4 Plasma level monitoring of imipramine recommended by some investigators does not seem to be appropriate.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Plasma levels and clinical response with imipramine in a study comparing efficacy with mianserin and nomifensine.

Montgomery¹,

Roy²,

Wynne‐Willson³

et al. 1983

Brit J Clinical Pharma

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“…In order to compare the overall response in different populations, a uniform criterion is needed, and a score of 6 or below on the 17-item Hamilton scale (HRS) (Hamilton 1960) has often been taken to indicate recovery. However, the MADRS was chosen for the present trial because of its apparently superior sensitivity in discriminating between antidepressive effects in different patient groups (Montgomery and Asberg 1979;Montgomery 1980). Several studies suggest that a MADRS score of 9 is approximately equivalent to 6 on the HRS Kearns et al 1982;Snaith et al 1986).…”

Section: Discussionmentioning

confidence: 99%

Antidepressive effect of amitriptyline treatment with plasma drug levels controlled within three different ranges

et al. 1988

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Seventy-four depressed patients were treated with amitriptyline for 4-6 weeks. Their doses were individually adjusted to maintain the sum of the plasma levels of amitriptyline (AT) and nortriptyline (NT) within one of three different ranges, randomly allocated. Allowance was made for individual plasma binding of the drugs. In the 50 patients between 25 and 65 years of age, the antidepressive response at low plasma drug levels was somewhat poorer than at medium or high levels, which were equally effective. In this age group an association was found between outcome and the individual rate of AT metabolism, expressed as "reciprocal clearance" (RC), the steady-state plasma concentration of AT plus NT divided by the daily AT dose. Good antidepressive outcome was associated with high RC. The implications of these findings for patient treatment and for the interpretation of other studies are discussed. The 18 patients between 65 and 80 years of age showed no significant differences between the effectiveness of treatment at different plasma drug levels, and no significant associations between outcome and RC.

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“…However, this view is justified only if the methods used in biological psychiatry have been controlled and satisfy as stringent criteria as they are accepted in clinical chemistry (12). However, this view is justified only if the methods used in biological psychiatry have been controlled and satisfy as stringent criteria as they are accepted in clinical chemistry (12).…”

Section: Resultsmentioning

confidence: 99%

Quality Control of Amitriptyline and Nortriptyline Plasma Level Assessments

Baumann¹,

Breyer-Pfaff²,

Hj³

et al. 1982

Pharmacopsychiatry

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Numerous studies report about the relationship between the clinical effectiveness of amitriptyline (At) and the plasma level of this drug and of its most important metabolite, nortriptyline (Nt). These agents are therefore very frequently examined for clinical applications and for research programmes in specialized laboratories. The experience with antiepileptic drugs suggests the necessity of quality controls for antidepressants also. Therefore, five institutions in Western Europe performed two such experiments within a year. Two kinds of blood samples were sent for analysis: 1. plasma samples spiked with different quantities of At and Nt from an untreated subject; 2. plasma samples from patients treated with clinical doses of At. Each laboratory happened to use a different analytical method: TLC, HPLC, GC-NPD, GC-FID and GC-MS. The results clearly show the usefulness and the necessity of quality controls for this category of drugs as well. They form the basis for the improvement of the methods of each laboratory in particular. In this context, intralaboratory quality controls are also possible, if one disposes of two different methods. The findings of this study suggest that published reports on relationships between clinical and pharmacological parameters should be considered critically as to possible methodological bias.

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Measurement of Serum Drug Levels in the Assessment of Antidepressants

Cited by 8 publications

References 37 publications

Plasma levels and clinical response with imipramine in a study comparing efficacy with mianserin and nomifensine.

Plasma levels and clinical response with imipramine in a study comparing efficacy with mianserin and nomifensine.

Antidepressive effect of amitriptyline treatment with plasma drug levels controlled within three different ranges

Quality Control of Amitriptyline and Nortriptyline Plasma Level Assessments

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