Optimization of Psychiatric Treatment through Therapeutic Drug Monitoring

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: 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: 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: 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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