Antidepressants

Tricyclic antidepressants (TCAs)

• AMTRP | Amitriptyline and Nortriptyline, Serum
  • Useful for monitoring amitriptyline and nortriptyline serum concentrations during therapy to avoid toxicity, especially in children and poor metabolizers of CYP2D6.
• CLOM | Clomipramine, Serum
  • Determines whether a poor therapeutic response is attributable to noncompliance or can aid in dose optimization.
• DESPR | Desipramine, Serum
  • Useful for evaluating desipramine (Norpramin) toxicity and/or patient compliance.
• DXPIN | Doxepin and Nordoxepin, Serum
  • Useful for evaluating doxepin toxicity and patient compliance.
• IMIPR | Imipramine and Desipramine, Serum
  • Useful for evaluating imipramine and desipramine toxicity and patient compliance.
• NOTRP | Nortriptyline, Serum
  • Useful for evaluating nortriptyline toxicity and patient compliance.
• TRMP | Trimipramine, Serum
  • Useful for evaluating trimipramine toxicity and patient compliance.

Select serotonin reuptake inhibitors (SSRIs)

• DULOX  | Duloxetine, Serum
  • Useful for monitoring serum concentrations during therapy to evaluate potential toxicity and patient compliance.
• FLUOX | Fluoxetine, Serum
  • Useful for managing co-medications, dose, or formulation changes, and in assessing compliance.

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mood stabilizers

Key testing

• CARBG | Carbamazepine-10,11-Epoxide, Serum
  • Useful for monitoring patients exhibiting symptoms of carbamazepine toxicity whose total serum carbamazepine concentration is within the therapeutic range, but who may be producing significant levels of the active metabolite epoxide, which can accumulate to concentrations equivalent to carbamazepine.
• CARF | Carbamazepine, Free, Serum
  • Useful for monitoring carbamazepine therapy in patients with altered or unpredictable protein binding capacity.
• CARFT | Carbamazepine, Free and Total, Serum
  • Useful for monitoring carbamazepine free and total serum levels in uremic patients.  
• CARTA | Carbamazepine, Total, Serum
  • Measures total carbamazepine levels in serum.
• CARTF | Carbamazepine Profile, Serum
  • Measures carbamazepine free, total and carbamazepine-10,11-epoxide levels in serum.  
• LAMO | Lamotrigine, Serum
  • Useful for adjusting lamotrigine in patients concurrently prescribed phenytoin, carbamazepine, or valproic acid therapy.
• LITH | Lithium, Serum
  • Identifies lithium toxicity.
• VALPF | Valproic Acid, Free, Serum
  • Useful for evaluating toxicity and monitoring free valproic acid serum levels.
• VALPG | Valproic Acid, Free and Total, Serum
  • Useful for monitoring total and free valproic acid levels in therapy.

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References

1. Undurraga J, Baldessarini RJ. Randomized, placebo-controlled trials of antidepressants for acute major depression: thirty-year meta-analytic review. Neuropsychopharmacology. 2012;37:851–64
2. Tansey KE, Guipponi M, Hu X, et al. Contribution of common genetic variants to antidepressant response. Biol Psychiatry. 2013 Apr 1;73(7):679-82. doi:10.1016/j.biopsych.2012.10.030. Epub 2012 Dec 11. PMID: 23237317
3. Hiemke C, Bergemann N, Clement HW, et al. Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology. Pharmacopsychiatry. 2018;51. 9-62. http://dx.doi.org/10.1055/s-0043-116492