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Studies have shown the beneficial effects of Therapeutic Drug Monitoring (TDM) for some antidepressant (tricyclic antidepressants) and antipsychotic drugs (e.g. haloperidol or clozapine). For these drugs, TDM should be used as standard care. Moreover, TDM is useful for a number of specific indications such as control of compliance, drug-drug interactions, comorbidity, nonresponse, or unexpected side effects. In practice, blood should be taken under steady state conditions and analytical methods should be sufficiently sensitive (lower limit of quantification about 5 to 50 ng/ml) and precise (day-to-day variabilities below 20%). Chromatographic methods are suitable, whereas immunoassays for antidepressants and radioreceptor assays for antipsychotics have insufficient reliability. TDM results should be reported with inclusion of a qualified comment as soon as possible after blood withdrawal. The clinical decision must consider not only blood levels but also time under drug therapy, clinical improvement and side effects. Some studies have shown an economical impact of TDM. The potential beneficial effects of TDM in anti-psychotic and anti-depressive drug therapy are not adequately utilized, since psychiatrists order these tests too rarely.

Therapeutisches Drug Monitoring von Antidepressiva und Antipsychotika/Therapeutic monitoring of antidepressant and antipsychotic drugs