Tricyclic antidepressant concentrations in plasma: an estimate of their sensitivity and specificity as a predictor of response

J Clin Psychopharmacol. 1994 Aug;14(4):230-40.

Abstract

An analysis of the literature on tricyclic antidepressant level in blood using receiver operating characteristics curves as the primary statistical tool was performed. For nortriptyline, a significant curvilinear relationship between therapeutic response and nortriptyline was observed that ranged from 58 to 148 ng/ml. The sensitivity and specificity for the nortriptyline therapeutic window were 78 and 61%, respectively. The response rate within the therapeutic range was 66% versus 26% outside the therapeutic range. For desipramine, a significant linear relationship between therapeutic response and desipramine concentration in plasma was observed. The threshold concentration in plasma for therapeutic response was 116 ng/ml. The sensitivity and specificity for the desipramine threshold level in blood were 81 and 59%, respectively. The response rate above the threshold level was 51% versus 15% below the therapeutic threshold concentration. For imipramine, a significant curvilinear relationship between therapeutic response and total imipramine (imipramine+desipramine) concentration in plasma was observed between 175 and 350 ng/ml. The sensitivity and specificity for the total imipramine concentrations in plasma were 52 and 74%, respectively. The response rate within the therapeutic range was 67% versus 39% outside the therapeutic range. For amitriptyline, a significant curvilinear relationship between therapeutic response and total amitriptyline (amitriptyline+nortriptyline) concentration in plasma was observed between 93 and 140 ng/ml. The sensitivity and specificity for the total imipramine concentrations in plasma were 37 and 80%, respectively. The response rate within the therapeutic range was 50% versus 30% outside the therapeutic range.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Amitriptyline / administration & dosage
  • Amitriptyline / adverse effects
  • Amitriptyline / pharmacokinetics
  • Antidepressive Agents, Tricyclic / administration & dosage
  • Antidepressive Agents, Tricyclic / adverse effects
  • Antidepressive Agents, Tricyclic / pharmacokinetics*
  • Clinical Trials as Topic
  • Depressive Disorder / blood*
  • Depressive Disorder / drug therapy
  • Depressive Disorder / psychology
  • Desipramine / administration & dosage
  • Desipramine / adverse effects
  • Desipramine / pharmacokinetics
  • Dose-Response Relationship, Drug
  • Drug Monitoring
  • Female
  • Humans
  • Imipramine / administration & dosage
  • Imipramine / adverse effects
  • Imipramine / pharmacokinetics
  • Male
  • Middle Aged
  • Nortriptyline / administration & dosage
  • Nortriptyline / adverse effects
  • Nortriptyline / pharmacokinetics
  • ROC Curve
  • Sensitivity and Specificity

Substances

  • Antidepressive Agents, Tricyclic
  • Amitriptyline
  • Nortriptyline
  • Imipramine
  • Desipramine