HIGH-DOSE TERTIARY AMINE TRICYCLIC ANTIDEPRESSANTS IN THE TREATMENT OF SEVERE REFRACTORY DEPRESSION - THE CENTRAL ROLE OF PLASMA-CONCENTRATION ESTIMATIONS

Citation
Ad. Hodgkiss et al., HIGH-DOSE TERTIARY AMINE TRICYCLIC ANTIDEPRESSANTS IN THE TREATMENT OF SEVERE REFRACTORY DEPRESSION - THE CENTRAL ROLE OF PLASMA-CONCENTRATION ESTIMATIONS, Human psychopharmacology, 10(5), 1995, pp. 407-415
Citations number
30
Categorie Soggetti
Psychology,Psychology,"Pharmacology & Pharmacy",Neurosciences
Journal title
ISSN journal
08856222
Volume
10
Issue
5
Year of publication
1995
Pages
407 - 415
Database
ISI
SICI code
0885-6222(1995)10:5<407:HTATAI>2.0.ZU;2-O
Abstract
The relationships between dosage, plasma concentration, antidepressant response and toxicity were investigated in 24 highly selected patient s with severe, refractory major depression who were prescribed amitrip tyline, clomipramine or dothiepin at high dosage (150-525 mg/day), usu ally in combination with lithium or other psychotropics. Of serious ad verse effects 83 per cent were encountered when tricyclic antidepressa nt (TCA) plasma concentrations exceeded 400 mcg/l. Therapeutic drug mo nitoring of high dose TCAs is useful in minimizing the risk of toxicit y and in revealing poor compliance, undertreatment and pharmacokinetic interactions which can mitigate against drug efficacy, The value of c arbamazepine in the management of refractory depression in the context of unipolar affective disorder is put into question.