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Antidepressant plasma levels and clinical response in depressed patients treated with oxaprotiline and doxepin.

Relationship between plasma levels of a new tetracyclic antidepressant oxaprotiline and a tricyclic antidepressant doxepin, the clinical response and side-effects was studied in 30 patients with primary endogenous depression. Patients were treated following a placebo wash-out period with gradually increasing doses (75, 150, 225 mg/day) of either drug for 4 weeks. The clinical outcome (percentage of responders and of decrease in HAMD scores) was similar in groups of patients treated with the two drugs. No significant relationship was found between the plasma levels of the parent drugs (oxaprotiline or doxepin) and a measure of clinical response (HAMD scores). However, in patients treated with doxepin, there was a significant relationship between the therapeutic response and plasma levels of the drug's metabolite, desmethyldoxepin. In addition, side-effects were more frequently observed in patients with higher plasma levels of both drugs. Incidences of anticholinergic side-effects was significantly higher in patients treated with doxepin.