Key result
Paroxetine plasma concentrations show no link to treatment response, adverse events, or depression severity.
Why the study?
Clinical evidence supporting the measurement of serum concentrations of SSRIs like paroxetine to optimize treatment results in major depression is sparse.
Does routine screening of paroxetine plasma concentrations correlate with clinical response in patients with major depression?
Observational (n=40)
Does routine screening of paroxetine plasma concentrations correlate with clinical response in patients with major depression?
Routine screening of paroxetine plasma concentrations is not supported in clinical practice as plasma levels do not correlate with clinical response at the end of treatment.
Paroxetine levels unrelated to response or adverse events in this cohort; does not support routine monitoring and leaves open need for prospective trials.
BACKGROUND: In analogy to tricyclic antidepressants, serum concentrations of selective serotonin reuptake inhibitors (SSRIs) are frequently measured in order to optimize treatment results. However, clinical evidence for this approach is sparse. METHODS: Forty patients with major depression were treated with paroxetine 20 mg/day for 14 days and with 40 mg/day for further 49 days. Treatment response measured by Hamilton depression rating scales (HAMD) was correlated with paroxetine plasma concentrations. RESULTS: There was a significant difference between paroxetine plasma levels at 20 and 40 mg/day, respectively [20 mg/d: median 24 (range 4-358); 40 mg/d: 92 (30-398)]. However, the interindividual variance was very large. 18 out of 40 patients responded to paroxetine treatment. CONCLUSIONS: Receiver operated characteristic (ROC) analysis suggested no upper or lower limit of response. Responder had significantly higher paroxetine levels at day 7 [responder: 33 (4-107); non-responder: 13 (3-77)] but not at the end of the study [responder 93 (30-361); non-responder: 94 (59-398)]. Furthermore, plasma levels were not related to adverse events, age, body weight or severity of depression. These findings do not support any need for a routine screening of paroxetine plasma concentrations in clinical practice.
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Normann et al. (2004) conducted an observational in Major depression (n=40). Paroxetine was evaluated on Treatment response measured by Hamilton depression rating scales (HAMD). Paroxetine plasma concentrations at the end of the study did not differ between responders and non-responders (median 93 vs 94) and were not related to adverse events or depression severity.
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