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Treatment of Major Depression · Journal article
Translational Psychiatry · August 1, 2026
Encouraging direction, but not yet definitive.
In a tertiary referral center cohort of 383 inpatients with major depressive disorder, therapeutic drug monitoring frequency of ≥0.66/week was associated with 21 days shorter hospitalization and 37% cost reduction. This retrospective observational finding suggests a potential benefit but requires prospective, randomized validation and assessment of transferability to other settings.
Retrospective cohort study. Inpatients (N=383) with major depressive disorder receiving therapeutic drug monitoring of antidepressants, 2015–2021, with hospital stay ≥7 days and first TDM request at admission. Tertiary referral center.. Intervention: Therapeutic drug monitoring of antidepressants at frequency ≥0.66/week combined with treatment adaptations.. Compared with: Lower TDM frequency (<0.66/week).. n = 383. Single tertiary referral center (country not specified in abstract)..
Minimum effective TDM frequency of 0.66/week associated with mean reduction in hospitalization duration of 21 days (p < 2.2*10−16) Upper effective threshold approximated at 1.3/week TDM frequency Higher TDM frequency associated with more therapy adjustments within 7 days: dose adaptations (p = 3.07*10−16) and drug initiation/discontinuation (p = 6.70*10−6)
Higher TDM frequency associated with more therapy adjustments within 7 days: dose adaptations (p = 3.07*10−16) and drug initiation/discontinuation (p = 6.70*10−6)
These findings suggest biweekly therapeutic drug monitoring combined with timely treatment adaptations may reduce hospitalization duration and costs in tertiary referral settings for severe depression. However, the retrospective design and single-center setting limit immediate clinical translation; prospective trials and evaluation in diverse settings are needed before widespread adoption.
Retrospective observational study showing association between therapeutic drug monitoring frequency and reduced hospitalization duration with cost savings, but lacks randomization, prospective design, and external validation.
As stated by the source record.
Quoted from the source exactly as published.
These findings suggest biweekly therapeutic drug monitoring combined with timely treatment adaptations may reduce hospitalization duration and costs in tertiary referral settings for severe depression. However, the retrospective design and single-center setting limit immediate clinical translation; prospective trials and evaluation in diverse settings are needed before widespread adoption.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract In psychiatry, therapeutic drug monitoring (TDM) is routinely used to improve treatment safety and efficacy, yet its association with hospitalization duration and cost-effectiveness remains unclear. We hypothesized that the frequency of routinely requested TDM is associated with hospitalization duration. In this retrospective study, patients with major depressive disorder receiving TDM of antidepressants between 2015 and 2021 ( N = 383) were analyzed. Inclusion criteria were a hospital stay ≥7 days and a first TDM request at admission. Regression analyses assessed associations between TDM frequency and hospitalization duration. Receiver operating characteristic analysis identified a minimum effective TDM frequency of 0.66/week, which was associated with a mean reduction in hospitalization duration of 21 days ( p < 2.2*10 − ¹⁶). The upper effective threshold was approximated at 1.3/week. Higher TDM frequency was associated with more therapy adjustments within 7 days after TDM, including dose adaptations ( p = 3.07*10 − ¹⁶) and drug initiation/discontinuation ( p = 6.70*10 −6 ). Drug-specific analyses for amitriptyline, venlafaxine, and mirtazapine confirmed these associations. Cost-effectiveness analysis demonstrated a 37% cost reduction for patients with TDM frequencies ≥0.66/week. In conclusion, frequent, clinically integrated TDM of antidepressants and timely treatment adaptations were associated with shorter hospitalization and reduced hospitalization costs. These findings suggest that at least biweekly TDM combined with subsequent treatment adaptations may represent a previously underappreciated strategy to improve clinical and economic outcomes in a tertiary referral center for severe major depression. Whether these findings are transferable to other inpatient and outpatient settings of depression care requires further studies.
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