Therapeutic Drug Monitoring (TDM) in neuropsychopharmacology: How far are we from therapeutic ranges in children and adolescents?

Therapeutic drug monitoring (TDM) is a multidisciplinary approach that allows personalized pharmacotherapy during routine clinical practice. By measuring the drug's blood concentration at specific time points within a dosing interval, TDM is able to support the clinician’s decisions and promote dosing adjustments. Non-response at therapeutic doses, uncertain drug adherence, suboptimal tolerability, or pharmacokinetic drug-drug interactions are typical indications for TDM. Despite its potential, the application of TDM to neuropsychopharmacology is still far from routine. In fact, there is a general disagreement between the information on TDM in official product information and existing medico-scientific evidence. Even for well-studied compounds, such as amitriptyline or clozapine, insufficient information on TDM is found in the product information (Summary of Product Characteristics, SPC). Although several recommendations have been issued for TDM of psychiatric drugs in adults, specific guidelines for pediatric patients are still lacking.The use of anxiolytic, antidepressant, mood stabilizing, and antipsychotic drugs is dramatically increasing among children and adolescents. Nowadays, frenetic rhythms of life, the “obsessive” research of new fashions and idols to follow, and the spread of bullying and discrimination episodes among adolescents have significantly increased the incidence of psychiatric and behavioral disorders among children. Moreover, attention deficit disorders are typically more frequently diagnosed in young subjects during their scholarly life. Similarly, frustration derived from poorly accepted physical aspects or anxiety generated from high scholastic expectations that are not always achievable is often a trigger to eating disorders or anxiety associated with depressant syndromes. Finally, an increase in the number of mental health-related difficulties - including an upsurge of suicidal ideation and attempts among adolescents - has been reported in many countries during the COVID-19 pandemic. Despite the spread of neuropsychiatric drugs among young people, there is an evident gap in knowledge about the use of these medications in children and adolescents. Considering the numerous side effects that characterize these drugs, a tailored administration in pediatric patients should be highly desirable. Therefore, the application of TDM protocols during routine clinical practice could help clinicians optimize dose strategies in pediatric patients, thus lowering the risks of side effects.This Research Topic aims to collect scientific evidence proving the utility of TDM for the optimization of psychiatric therapies in children and adolescents, to address the following question: how far are we from guidelines for TDM in pediatric neuropsychopharmacology? In this optic, a recent research article highlights the utility of pediatric TDM for Selective Serotonin Reuptake Inhibitors (SSRI) (Strawn JR et al., 2021). Specific themes that the editors would like to see addressed include:&#8226 TDM-based pharmacometrics approaches including both population PK (popPK) and physiologically based pharmacokinetic (PBPK) studies&#8226 Model-based therapy individualization using TDM approach in pediatric patients&#8226 TDM as the main tool for conducting PK studies on children/adolescents&#8226 Bioanalytical methods and alternative microsampling procedures applied to PK studies or TDM during routine clinical practice&#8226 Case Reports highlighting the importance of performing TDM in order to avoid risks of therapeutic failures or adverse drug reactions (ADRs) in pediatric patients&#8226 Articles describing the “state-of-the-art” of TDM applied to pediatric neuropsychopharmacologyWe welcome article types including (but not limited to): Original Research, Study Protocols, Case Reports, and Review article types. Topic editors: Raffaele Simeoli, Alessandra Manca Source: https://www.frontiersin.org/research-topics/77162/therapeutic-drug-monitoring-tdm-in-neuropsychopharmacology-how-far-are-we-from-therapeutic-ranges-in-children-and-adolescents