Chapter 11 - Therapeutic drug monitoring of antidepressants and psychoactive drugs

Abstract

Depression is a major problem not only in the United States but throughout the world. It is estimated that 10–20% of adults in the United States experience major depression during their lifetime and ~3% of the population is depressed at any given time. Drugs available for treating depression can be broadly classified under five categories: monoamine oxidase inhibitors (MAOIs) such as phenelzine, selegiline, and tranylcypromine, tricyclic antidepressants (TCAs) such as amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, maprotiline, protripytline, and trimipramine, selective serotonin reuptake inhibitors (SSRIs) such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline, serotonin-norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine, duloxetine, levomilnacipran, milnacipran, and venlafaxine and atypical antidepressants such as bupropion, mirtazapine, nefazodone, trazodone, and vortioxetine. Out of all these drug classes, routine therapeutic drug monitoring of tricyclic antidepressants are essential while therapeutic drug monitoring of selected SSRIs may be beneficial.