Biggs J T, Chang S S, Sherman W R, Holland W H
J Nerv Ment Dis. 1976 Jan;162(1):46-51. doi: 10.1097/00005053-197601000-00007.
Although definitive studies regarding the correlation between tricyclic antidepressant plasma levels and therapeutic effect are lacking, preliminary data suggest that measurement of tricyclic antidepressant plasma levels provides a rational approach to improve clinical management of the depressed patient. Data were collected to determine if the routine measurement of plasma tricyclic antidepressant levels was practical in a large clinic population, and to determine if such levels could improve patient care. Individual differences in drug metabolism and frequent unreliable ingestion of medication make the measurement of drug plasma levels the only sure means of determining if a patient is receiving a fair therapeutic trial on a particular tricyclic antidepressant. Plasma analysis revealed both the failure to ingest adequate amounts of medication as prescribed and also the abuse of medications. Although generalizations regarding individual variation in drug metabolism or generalizations concerning drug compliance do little to improve patient care, whenever such problems are met on an individual basis, many clinical management problems can be resolved.
尽管缺乏关于三环类抗抑郁药血浆水平与治疗效果之间相关性的确定性研究，但初步数据表明，测量三环类抗抑郁药血浆水平为改善抑郁症患者的临床管理提供了一种合理的方法。收集数据以确定在大量临床人群中常规测量血浆三环类抗抑郁药水平是否可行，并确定这些水平是否能改善患者护理。药物代谢的个体差异以及药物摄入经常不可靠，使得测量药物血浆水平成为确定患者是否正在接受特定三环类抗抑郁药合理治疗试验的唯一可靠方法。血浆分析揭示了未按规定摄入足够量药物的情况以及药物滥用情况。虽然关于药物代谢个体差异的概括或关于药物依从性的概括对改善患者护理作用不大，但每当在个体层面遇到此类问题时，许多临床管理问题都可以得到解决。
