TRICYCLIC ANTIDEPRESSANTS;
EFFICACY OF THE TREATMENT OF DEPRESSION, WITH AND WITHOUT THERAPEUTIC DRUG MONITORING; A COMPARATIVE STUDY
DOI:
https://doi.org/10.29309/TPMJ/2012.19.02.2009Keywords:
Tricyclic antidepressants (TCAs),, Amitriptyline,, Imipramine,, Depression,, Therapeutic Drug Monitoring (TDM).Abstract
Introduction: Despite advancements in the treatment of depression and availability of newer compounds, TCAs like
amitriptyline remain to be the cornerstone of antidepressive therapy for more than three decades, however significantly more patients receiving
a tricyclic withdraw from treatment mainly because of side effects. Higher response, lower incidence of side effects and improved compliance
can be enhanced by the optimal use of Therapeutic Drug Monitoring (TDM). No research data is currently available on the therapeutic drug
monitoring of TCAs in Pakistan. Objectives: To compare the relative efficacy of Tricyclic antidepressant in the treatment of depression, with and
without Therapeutic Drug Monitoring Main Outcome Measures: Changes in HAMD scores in patients on TCAs. Study Design: A Quasi
experimental study design was used. Setting: The study was conducted at Department of Psychiatry, Military Hospital Rawalpindi. Subjects:
34 patients completed the study in the monitored group (with TDM) and 33 in control group (without TDM). Methods: Serum TCA levels and
HAMD scores at baseline and subsequently at sixth, eighth and tenth week of treatment were collected. In all the subjects, all the blood samples
were drawn as a fasting sample in early morning. Results: The mean age of the monitored group was 31.97 years (SD=10.432) while that of the
control group was 33.52 years (SD=9.385). in the monitored group 20 (58.82 %) of the patients were males while 14 (41.17%) were females, in
the control group 22 (66.66%) were males and 11(33.33%) were female patients. A significant reduction in HAMD scores was noted at 8 weeks
of treatment. The groups did not differ in terms of efficacy of TCAs, however the monitored group had fewer dropouts than the control group.
Conclusions: Lower incidence of side effects and improved compliance can be enhanced by the optimal use of Therapeutic Drug Monitoring
(TDM) of TCAs.
