Antidepressant drugs: Additional clinical uses

Three decades of psychiatric practice with tricyclic, tetracyclic, and heterocyclic antidepressants have shown that these drugs are effective not only for major depression, endogenous depression in particular, but also for a range of others disorders. Tricyclic and other antidepressants are now used to treat enuresis and attention-deficit disorders in children, bulimia and anorexia nervosa, panic disorder, posttrraumatic stress disorder, obsessive-compulsive disorder, chronic pain, migraine, and peptic ulcer disease. As with some of the antidepressants, the body of literature on the relationship between clinical response in these diseases and plasma or serum levels of the drugs is not complete or well understood, but for some of these disorders, sufficient preliminary serum level data are available to take advantage of therapeutic drug monitoring as an adjunct to treatment. Therapeutic monitoring can be particularly important where studies indicate that successful therapy occurs at blood levels substantially different from those used to treat depression. This paper presents a brief overview of antidepressant treatment of these disorders, focusing on the available pharmacologic data related to serum level measurements and their relation to clinical response.