Use of High-Resolution Mass Spectrometry in Therapeutic Drug Monitoring of Psychiatric Drugs

Psychiatric diseases are among the most challenging health issues in terms of human suffering, complex treatments, frequent treatment failure, high degrees of disability and sick leave usage, and high social expenditure. For many patients, chronic drug treatment is often required. However, many patients experience insufficient clinical effects or side effects. Therapeutic drug monitoring (TDM) of plasma/serum concentration of psychiatric drugs aims to facilitate precision dosing and improve outcomes. High-resolution mass spectrometry (HR-MS) is a powerful technique to refine TDM with excellent specificity and sensitivity by measuring the exact mass of drugs and metabolites. The benefits of such an analytical method include that many compounds can be measured simultaneously and with short run times. Additional applications include retrospective data reprocessing to reveal interacting comedications, active/toxic metabolites, and dosing biomarkers, in which researchers reprocess exact masses of stored HR-MS TDM files. This review illustrates the benefits of HR-MS-based TDM focusing on psychiatry and innovative applications.