文拉法辛
抗抑郁药
治疗药物监测
治疗指标
医学
治疗效果
内科学
萧条(经济学)
重性抑郁障碍
重性抑郁发作
麻醉
药理学
药品
药代动力学
经济
氢化可的松
扁桃形结构
宏观经济学
海马体
作者
Maike Scherf‐Clavel,Leif Hommers,Catherina Wurst,Saskia Stonawski,Jürgen Deckert,Katharina Domschke,Stefan Unterecker,Andreas Menke
标识
DOI:10.1177/0269881120936509
摘要
The therapeutic reference range for venlafaxine in antidepressant treatment has been defined as 100 to 400 ng/mL. However, in an everyday setting active moiety concentrations above the therapeutic reference range were often reported.The aim of this study was to re-evaluate the therapeutic reference range of venlafaxine.In-patients (⩽60 years) with major depressive episodes receiving antidepressant monotherapy with venlafaxine during routine clinical treatment were included in this observational study. Depressive symptom severity was evaluated on a weekly basis using the Hamilton Depression Rating Scale (HAMD-21), and therapeutic drug monitoring analyses were performed. Resting electrocardiograms were analyzed in week 3, week 5 and week 7 of study participation.Clinical improvement from baseline to week 4 was significantly associated with increasing serum concentrations of the active moiety of venlafaxine (N = 23, Pearson correlation, p = 0.009), but not with the dose of venlafaxine. Patients achieving remission showed significantly higher serum concentrations than patients achieving response/non-response (Kruskal-Wallis test, p = 0.019). Moreover, in patients with serum concentrations above 400 ng/mL time to remission and time to response was significantly shorter than in patients with concentrations below 400 ng/mL (Mantel-COX test, p = 0.001; p = 0.010). QTc time was below the upper limit of a normal QTc time (450 ms) for all patients.The serum concentration of the active moiety and not the dose determined the effect of venlafaxine. Shorter remission times without ECG alterations in patients with serum concentrations above the therapeutic reference range suggest a re-evaluation of the therapeutic reference range for venlafaxine in larger studies.
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