Finally, It would also be Interesting to study the above strategies in conjunction with pharmacogenomic approaches. Selected abbreviations and acronyms ACTH adrenocorticotropic hormone CRH corticotropin-releasing hormone DA dopamine DST dexamethasone suppression test GH growth hormone HPA hypothalamic-pituitary-adrenal (axis) HPT hypothalamic-pituitary-thyroid

(axis) NA noradrenaline PRL prolactin SSRI selective serotonin Inhibitors,research,lifescience,medical reuptake inhibitor T3 triiodothyronine T4 thyroxine TRH thryotropin-releasing hormone (protirelin) TSH thyroid-stimulating hormone (thyrotropin) Notes We would like to thank the nursing staff of Sector VIII and Françoise Fleck and Gabrielle Wagner, pharmacists, for performing the hormone analyses.
Pharmacopsychiatry and psychotherapy are beneficial for many patients with depression. Evidence-based and clinical experience collected Inhibitors,research,lifescience,medical during the past decades has allowed the introduction of guidelines and UMI-77 recommendations from experts in the field1-3 to optimize antidepressant pharmacotherapy. However, partial response and nonresponse are frequent,4 despite the introduction of new psychotropic Inhibitors,research,lifescience,medical agents, including ”third-generation

antidepressants,“5 and amelioration and remission rates are still far from optimal. The efficacy of available drugs can be increased, not only by the use of augmentation strategies6,7 and other combination treatments,8,9 but also by analysis of antidepressant drug concentrations in blood plasma.10 Recently, a group of psychiatrists, clinical pharmacologists, biochemists, and clinical chemists, all members of the AGNP (Arbeitsgemeinschaft fur Neuropsychopharmakologie und Inhibitors,research,lifescience,medical Pharmakopsychiatrie; www.agnp.de), worked out consensus guidelines for therapeutic drug monitoring (TDM) in psychiatry, after

Inhibitors,research,lifescience,medical they had compiled information from the literature.11 These guidelines were mainly based on the hypothesis that some inadequate or insufficient treatments of psychiatric patients can be explained by the fact that psychotropic drugs not only differ in their pharmacological profile, but also in their metabolism and pharmacokinetics in the individual patient. Treatment should therefore be adapted accord_ isothipendyl ing to this situation by using TDM and pharmacogenetic tests. This combined strategy takes into consideration the fact that the fate of the drug depends on both environmental (diet, smoking habits, comorbidities, and cornedications) and genetic factors. Pioneering work in this field was mainly carried out in Sweden, where the first study on the plasma concentration–clinical effectiveness relationship of an antidepressant (nortriptyline)12 was performed. This was an outstanding demonstration of the usefulness of the combination of TDM and pharmacogenetic tests (CYP 2D6) in a pharmacovigilance case situation.