psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2025-23-6-113-124psychiatry-1482Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSОптимизация психиатрического лечения с помощью терапевтического лекарственного мониторингаOptimization of Psychiatric Treatment through Therapeutic Drug Monitoringhttps://orcid.org/0000-0002-2613-8783БурыгинаЛ. А.BuryginaL. A.

Лариса Андреевна Бурыгина, кандидат медицинских наук, главный врач

Москва

Larisa A. Burygina, Cand. Sci. (Med.), Chief Medical Officer

Moscow

lar.burygina@yandex.ruhttps://orcid.org/0000-0002-0021-4936ГолубевС. А.GolubevS. A.

Сергей Александрович Голубев, доктор медицинских наук, заместитель главного врача по медицинской части, ГБУЗ «Психиатрическая клиническая больница №4 им. П.Б. Ганнушкина»; ведущий научный сотрудник, ФГБНУ «Научный центр психического здоровья»; профессор, кафедра психиатрии, ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента Российской Федерации

Москва

Sergey A. Golubev, Dr. Sci. (Med.), Deputy Chief Medical Officer, Psychiatric clinic No.4 named after P.B. Gannushkin; Leading Researcher, Mental Health Research Centre; Professor, Central State Medical Academy the Administrative Directorate of the President of the RF

Moscow

color1982@bk.ruhttps://orcid.org/0009-0007-8321-0052СергееваА. К.SergeevaA. K.

Сергеева Анна Константиновна, врач-психиатр

Москва

Anna K. Sergeeva, Psychiatrist

Moscow

annuta0509@mail.ruГБУЗ «Психиатрическая клиническая больница №4 им. П.Б. Ганнушкина ДЗМ»РоссияSBHI Psychiatric clinic No.4 named after P.B. GannushkinRussian FederationГБУЗ «Психиатрическая клиническая больница №4 им. П.Б. Ганнушкина ДЗМ»; ФГБНУ «Научный центр психического здоровья»; ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента Российской ФедерацииРоссияSBHI Psychiatric clinic No.4 named after P.B. Gannushkin; FSBSI “Mental Health Research Centre”; FSBI CPE Central State Medical Academy of the Administrative Directorate of the President of the Russian FederationRussian Federation202513022026236113124Copyright © Бурыгина Л.А., Голубев С.А., Сергеева А.К., 20262026Бурыгина Л.А., Голубев С.А., Сергеева А.К.Burygina L.A., Golubev S.A., Sergeeva A.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/1482Обоснование

Обоснование: в условиях развития персонализированной медицины особую значимость приобретает терапевтический лекарственный мониторинг (ТЛМ), позволяющий повысить безопасность и эффективность психофармакотерапии.

Цель работы

Цель работы: систематизация и обобщение данных современных исследований, посвященных применению ТЛМ в психиатрической практике.

Материал и методы

Материал и методы: проведен обзор статей в базе данных PubMed, опубликованных за период с 2018 по 2024 г., с использованием ключевых слов, отражающих применение ТЛМ для различных групп психотропных препаратов (антипсихотиков, антидепрессантов, нормотимиков). Анализ включал рекомендации рабочей группы AGNP (Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie), а также исследования новых подходов к забору биоматериала.

Результаты

Результаты: в анализированных работах приведены клинические обоснования регулярного применения ТЛМ при назначении препаратов с узким терапевтическим окном (клозапин, литий, вальпроат). Обсуждается способность ТЛМ выявлять индивидуальные особенности метаболизма, оценивать комплаентность, предотвращать псевдорезистентность. Исследователи отмечают ограниченность данных о корреляции «концентрация-эффект» для большинства антидепрессантов. Рассмотрены альтернативные методы мониторинга (анализ слюны, микропроб крови), позволяющие повысить доступность процедуры.

Выводы

Выводы: ТЛМ представляет собой эффективный инструмент оптимизации психиатрического лечения, особенно при применении антипсихотиков и нормотимиков. Внедрение менее инвазивных методов и повышение информированности специалистов может способствовать более широкому использованию ТЛМ в клинической практике.

Background

Background: therapeutic drug monitoring (TDM) is becoming particularly important in the context of growing interest in personalized medicine, due to its ability to increase the effectiveness and safety of psychopharmacotherapy.

The aim was to systematize and summarize current research data on the use of TDM in psychiatric practice.

Material and Methods

Material and Methods: a narrative review was conducted using the PubMed database using keywords related to the use of TDM for various classes of psychotropic drugs (antipsychotics, antidepressants, mood stabilizers). The analysis included recommendations from the AGNP (Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie) working group as well as emerging methods for biological sample collection.

Results

Results: analized articles supports a clinical evidence of the regular use of TDM for medications with a narrow therapeutic window (clozapine, lithium, valproate). The authors discuss the ability of TDM to help identify individual metabolic differences, assess treatment adherence, and prevent pseudo-resistance. Limited data are available on the concentration-effect correlation for most antidepressants. Alternative monitoring methods (e.g., saliva and dried blood spot testing) are shown as potential ways to improve accessibility of TDM.

Conclusions

Conclusions: TDM is an effective tool for optimizing psychiatric treatment, especially with antipsychotics and mood stabilizers. The adoption of non-invasive methods of bio-material sampling and increased awareness among healthcare providers may contribute to broader implementation of TDM in clinical settings.

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The authors declare that there are no conflicts of interest present.