Tools for optimising pharmacotherapy in psychiatry (therapeutic drug monitoring, molecular brain imaging and pharmacogenetic tests): focus on antidepressants

C. B. Eap, G. Gründer, P. Baumann, N. Ansermot, A. Conca, E. Corruble, S. Crettol, M. L. Dahl, J. de Leon, C. Greiner, O. Howes, E. Kim, R. Lanzenberger, J. H. Meyer, R. Moessner, H. Mulder, D. J. Müller, M. Reis, P. Riederer, H. G. RuheO. Spigset, E. Spina, B. Stegman, W. Steimer, J. Stingl, S. Suzen, H. Uchida, S. Unterecker, F. Vandenberghe, C. Hiemke

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations


Objectives: More than 40 drugs are available to treat affective disorders. Individual selection of the optimal drug and dose is required to attain the highest possible efficacy and acceptable tolerability for every patient. Methods: This review, which includes more than 500 articles selected by 30 experts, combines relevant knowledge on studies investigating the pharmacokinetics, pharmacodynamics and pharmacogenetics of 33 antidepressant drugs and of 4 drugs approved for augmentation in cases of insufficient response to antidepressant monotherapy. Such studies typically measure drug concentrations in blood (i.e. therapeutic drug monitoring) and genotype relevant genetic polymorphisms of enzymes, transporters or receptors involved in drug metabolism or mechanism of action. Imaging studies, primarily positron emission tomography that relates drug concentrations in blood and radioligand binding, are considered to quantify target structure occupancy by the antidepressant drugs in vivo. Results: Evidence is given that in vivo imaging, therapeutic drug monitoring and genotyping and/or phenotyping of drug metabolising enzymes should be an integral part in the development of any new antidepressant drug. Conclusions: To guide antidepressant drug therapy in everyday practice, there are multiple indications such as uncertain adherence, polypharmacy, nonresponse and/or adverse reactions under therapeutically recommended doses, where therapeutic drug monitoring and cytochrome P450 genotyping and/or phenotyping should be applied as valid tools of precision medicine.

Original languageEnglish
Pages (from-to)561-628
Number of pages68
JournalWorld Journal of Biological Psychiatry
Issue number8
StatePublished - 2021

Bibliographical note

Funding Information:
Dr G Gründer has served as a consultant for Allergan, Boehringer Ingelheim, Institute for Quality and Efficiency in Health Care (IQWiG), Janssen-Cilag, Lundbeck, Otsuka, Recordati, Sage, and Takeda. He has served on the speakers’ bureau of Gedeon Richter, Janssen Cilag, Lundbeck, Otsuka, Recordati. He has received grant support from Boehringer Ingelheim, Lundbeck and Saladax. He is co-founder and/or shareholder of Mind and Brain Institute GmbH, Brainfoods GmbH, InMediCon GmbH, OVID Health Systems GmbH and MIND Foundation gGmbH.

Funding Information:
The authors acknowledge Lorraine Maw, M.A., from the University of Kentucky Mental Health Research Center at Eastern State Hospital, who helped in editing the article.

Funding Information:
Dr E Kim has participated in advisory/speaker meetings organised by Janssen Korea, Otsuka Korea, and Bukwang Pharm Company and received investigator-initiated research funding from Otsuka Korea.

Publisher Copyright:
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


  • Antidepressants
  • brain imaging
  • pharmacogenetics
  • precision medicine
  • therapeutic drug monitoring

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


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