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Desipramine Plasma Concentration and Antidepressant Response

J. Craig Nelson, MD; Peter Jatlow, MD; Donald M. Quinlan, PhD; Malcolm B. Bowers Jr, MD
Arch Gen Psychiatry. 1982;39(12):1419-1422. doi:10.1001/archpsyc.1982.04290120049010.
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• The relationship of desipramine hydrochloride plasma concentration and antidepressant response was determined in 30 depressed inpatients treated for three weeks with desipramine. All patients had a nondelusional unipolar depression, met DSM-III criteria for major depressive episode with melancholia, and had a Hamilton score of 18 or greater after one week of hospitalization without medication. Eightynine percent of the patients with plasma concentrations above 115 ng/mL responded, in contrast to 14% of those with concentrations below this level, a significant difference (Fisher's exact test, P<.001).. Ten initial nonresponders were converted to responders when dosage increase raised desipramine plasma concentration to 125 ng/mL or above. In clinical practice a plasma concentration of 125 ng/mL would be a useful guideline as a threshold above which desipramine is likely to be effective.

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