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Effects of gender and age on serum concentrations of antidepressants under naturalistic conditions

  • Psychiatry and Preclinical Psychiatric Studies - Original Article
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Abstract

Therapeutic drug monitoring (TDM) data of antidepressant drugs are often evaluated using homogeneous samples of selected individuals without psychiatric or somatic comorbidity. These data may have limitations in transferability to everyday clinical practice. Hence, studies under naturalistic conditions are important to clarify the full clinical relevance of TDM of antidepressants. TDM analyses were retrospectively evaluated for a 3-year period from 2008 to 2010. The influence of gender and age on dose-corrected serum concentrations of antidepressants was examined in a standard clinical setting. 693 TDM analyses of amitriptyline and nortriptyline (AMI + NOR), 160 of citalopram (CIT), 152 of clomipramine and N-clomipramine (CLO + N-CLO), 272 of doxepine and N-doxepine (DOX + N-DOX), 359 of escitalopram (ESC), 198 of fluoxetine and N-fluoxetine (FLU + N-FLU), 92 of maprotiline (MAP), 888 of mirtazapine (MIR), and 77 of sertraline (SER) remained in the sample. Females had significantly higher dose-corrected serum concentrations of AMI + NOR (32 %), CIT (29 %), DOX + N-DOX (29 %), and MIR (20 %), and patients older than 60 years had significantly higher dose-corrected serum concentrations of AMI + NOR (21 %), CIT (40 %), DOX + N-DOX (48 %), MAP (46 %), MIR (24 %), and SER (67 %). Comparing the two extreme groups, females >60 years showed a remarkably higher dose-corrected serum concentration of AMI + NOR (52 %), CIT (78 %), DOX + N-DOX (86 %), and MIR (41 %) in contrast to males ≤60 years. Gender and age have a significant influence on the serum concentrations of different antidepressant drugs, and additive effects must be considered. TDM is recommended to reduce the risk of adverse effects due to supratherapeutic serum levels, also in a naturalistic clinical setting.

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Acknowledgments

We are indebted to the staff of the TDM laboratory of the Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, R. Burger, M. Burger, R. Schreiner and M. Weyer.

Conflict of interest

S.U. has received travel and accommodation expenses by Astra Zeneca, Pfizer and Janssen. P.R. has received honorarium from Merz-Pharmaceuticals GmbH. J.D. has received speaker’s honoraria by Janssen, Bristol-Myers Squibb, Wyeth, Lundbeck, Astra Zeneca, and Pfizer and grant support by Medice. B.P. has received speaker’s honoraria by Astra Zeneca, Janssen, and Pfizer. No other relationships or activities that could appear to have influenced the submitted work.

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  1. Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Füchsleinstrasse 15, 97080, Würzburg, Germany

    S. Unterecker, P. Riederer, F. Proft, J. Maloney, J. Deckert & B. Pfuhlmann

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  1. S. Unterecker
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Correspondence to S. Unterecker.

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Unterecker, S., Riederer, P., Proft, F. et al. Effects of gender and age on serum concentrations of antidepressants under naturalistic conditions. J Neural Transm 120, 1237–1246 (2013). https://doi.org/10.1007/s00702-012-0952-2

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  • DOI: https://doi.org/10.1007/s00702-012-0952-2

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