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Pharmacopsychiatry 2014; 47(04/05): 174-179
DOI: 10.1055/s-0034-1383565
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Prediction of Antidepressant Response to Venlafaxine by a Combination of Early Response Assessment and Therapeutic Drug Monitoring

T. J. Stamm
1   Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
,
D. Becker
1   Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
,
L. M. Sondergeld
1   Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
,
K. Wiethoff
1   Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
,
C. Hiemke
2   Department of Psychiatry and Psychotherapy, Universitätsmedizin Mainz, Germany
,
G. O’Malley
3   School of Psychology, University College Dublin, Ireland
,
R. Ricken
1   Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
,
M. Bauer
4   Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
M. Adli
1   Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 27. September 2013
revised 30. Mai 2014

accepted 06. Juni 2014

Publikationsdatum:
23. Juli 2014 (online)

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Abstract

Introduction:  Early assessment of a therapeutic response is a central goal in antidepressant treatment. The present study examined the potential for therapeutic drug monitoring and symptom rating to predict venlafaxine treatment efficacy (measured by overall patient response and remission).

Methods:  88 patients were uptitrated homogenously to 225 mg/day venlafaxine. Serum concentrations of venlafaxine (VEN) and its active metabolite O-desmethylvenlafaxine (ODV) were measured at week 2. Continuous psychopathometric ratings were measured for up to 6 weeks by independent study raters.

Results:  An early improvement was significantly more common in venlafaxine responders than non-responders (χ2; p=0.007). While ODV serum levels were significantly higher in responders (t test; p=0.006), VEN serum levels, sum level of VEN+ODV and the ratio of ODV/VEN levels were not. Moreover, patients who showed an early response combined with an ODV serum level above the median of 222 ng/mL were significantly more likely to achieve full response (binary logistic model; p<0.01). Sensitivity (84% for early response) and specificity (81% for combination of early response and therapeutic drug monitoring) were sufficient to qualify as a reasonable screening instrument.

Conclusion:  Our results indicate that early improvement and ODV serum concentration are predictive of therapeutic outcome and can thus be used to guide use of the antidepressant venlafaxine.

Key words

depression - early response - therapeutic drug monitoring - treatment algorithm
 

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