Therapeutic drug monitoring in psychiatric practice : need and relevance in developing countries

Monitoring levels ofpsychopharmacological agents for the purpose of optimising treatment is being recommended for increasing number of situations in routine psychiatry practice by some western authors. As a result most psychiatrists in developed countries advise drug assays for many patients on psychopharmacological treatment. Even in developing countries like India, therapeutic drug monitoring (TDM) is being advised more frequently, thus creating a demand for facilities. This paper reviews the need & feasibility of TDM in developing countries focussing on cost effectiveness, ethnopharmacological and sociocultural issues. Recommendations are made for using TDM in developing countries only in certain specific & selected clinical situation. Cost-effectiveness of strict serum lithium monitoring is discussed from a community health point of view.