Personalizing tricyclic antidepressant treatment for major depressive disorder

Abstract

In the treatment of depression with antidepressants, effectiveness varies widely between patients and adverse effects are common. This thesis shows that a more personalized approach to tricyclic antidepressant (TCA) treatment can improve clinical outcomes. The findings demonstrate substantial variation in current prescribing and dosing practices. Personalized dosing strategies, such as dosing guided by genetic characteristics or early plasma concentrations, enable faster attainment of therapeutic doses and are associated with fewer adverse effects. In addition, specific pharmacological characteristics, including the ratio between active metabolites, are linked to improved effectiveness and tolerability. Early clinical signals, such as improvement in sleep during the first weeks of treatment, also predict later treatment response. Together, these results indicate that tailoring antidepressant treatment to the individual patient can make depression treatment safer and more effective.