Therapeutic Drug Monitoring in a Naturalistic Clinical Setting

Therapeutic Drug Monitoring (TDM) has until now become a routine procedure for many psychopharmacotherapeutical interventions. Its aim is to optimize treatment with antidepressants, neuroleptics and mood stabilizers in the sense of a maximization of the therapeutic effect and a minimization of the toxicity risk. However, data about existing „therapeutic windows“ of psychotropic medications are often obtained from study samples comprised of highly cooperative and selected individuals. Such probands may not be representative for the „average psychiatric patient“ and such studies may thus provide only limited information for the everyday use of psychotropic drugs. Therefore studies with sufficient numbers of unselected patients in a naturalistic clinical setting are of primary importance to clarify the full clinical relevance of TDM in psychopharmacotherapy. To obtain more information about the benefits of TDM under naturalistic conditions, we investigated therapeutic effects and adverse reactions of typical and atypical neuroleptic agents as well as antidepressants in relation to plasma concentrations measured in an unselected collective of patients of a psychiatric university clinic in a standard therapeutical setting. We also examined the influence of gender and age on the clinical response as well as on the frequency of side effects in relation to the plasma levels of the psychotropic drugs. The results of these investigations will be discussed in view of existing data about „therapeutic windows“ in neuroleptics and antidepressants.