Compliance with SSRI medication during 6 months of treatment for major depression: an evaluation by determination of repeated serum drug concentrations

Reis, Margareta; Åberg-Wistedt, Anna; Ågren, Hans; Åkerblad, Ann-Charlotte; Bengtsson, Finn

doi:10.1016/j.jad.2004.02.003

« Previous Next »Journal of Affective Disorders
Volume 82, Issue 3 , Pages 443-446, 1 November 2004

Compliance with SSRI medication during 6 months of treatment for major depression: an evaluation by determination of repeated serum drug concentrations

Margareta Reis
- Corresponding author. Institute of Laboratory Medicine, Department of Clinical and Experimental Pharmacology, Lund University Hospital, SE 221 85 Lund, Sweden. Tel.: +46-703-20-00-04; fax: +46-46-211-1987.
- Division of Clinical Pharmacology, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Pharmacology, Lund University, Lund, Sweden
Anna Åberg-Wistedt
- Karolinska Institute, Department of Psychiatry, Stockholm, Sweden
Hans Ågren
- Karolinska Institute, Neurote Department, Division of Psychiatry, Huddinge, Sweden
Ann-Charlotte Åkerblad
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
Finn Bengtsson
- Division of Clinical Pharmacology, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Pharmacology, Lund University, Lund, Sweden

Received 1 May 2003; received in revised form 16 February 2004; accepted 16 February 2004.

Abstract

Background: A recent estimation in a psychiatric cohort showed numbers of noncompliance between 10% and 60%. Therapeutic drug monitoring (TDM) is one method assessing compliance by analysis of drug concentration in the blood. Method: During a 24-week phase IV clinical trial, five repeated serum samples of sertraline (SERT) and N-desmethylsertraline (DSERT), trough values in steady state, were collected per patient. Previous results show that the intraindividual variation over time of the ratio DSERT/SERT is low. Hence, we hypothesized that significant partial noncompliance could be scrutinized further by an assessment of the DSERT/SERT ratio. The main aim was to test the applicability of a novel type of TDM procedure based on repeated metabolite/parent compound ratio measurements. Result: 9.4% of the per-protocol population in the trial (n=96) were in either hidden total (n=4) or hidden partial (n=5) noncompliance. Only by using the novel TDM ratio screening method could a majority of these patients be identified.

Keywords: SSRI, Depression, Sertraline