Clinical Information

Laboratory tests

Depending on what medication therapy you are on and during the early phase of your treatment, and periodically thereafter, I will order lab tests to determine the level of medication present in your blood. Everyone absorbs and metabolizes drugs differently, and I will have to examine your drug level lab tests and adjust your dosage to obtain the optimum level of the drug in your blood.

This applies to medications that I commonly use that have clinically useful blood levels. Blood levels are believed to be proportional to brain levels, which we currently cannot easily measure.

Drug blood levels are always done 12 hours after the last dose, at least seven days after any dosage changes, up or down. This assumes you are taking your meds faithfully, and you haven’t missed a dose recently. Fasting before a lab test is only required for blood sugars, cholesterol, and triglyceride testing.

If you are interested, you can also follow your blood levels as I titrate them with you. The goal of medication titration is to get your medication blood levels into the therapeutic range, so there is enough of the medication in your blood to produce a positive result, and not so much that the drug becomes toxic or has severe side effects. Therapeutic ranges for drugs (TSH stands for "thyroid stimulating hormore," and is not a drug) typically used in therapy are as follows:

Drug Therapeutic level
Anafranil/clomipramine 220 to 500 ng/mL
Depakote/valproic acid 50 to 100 ug/mL
Elavil/amitryptyline 120 to 150 ngl/L
Lamictal/lamotrigine 3.0 to 14.0 mcg/mL
lithium 0.5 to 1.0 mmol/L
Tegretol/carbamazepine 4.0 to 12.0 ug/mL
Tofranil/imipramine 150 to 300 ng/mL
Trileptal/oxcarbazepine 3 to 35 mcg/mL
TSH (thyroid test) 0.45 to 5.10 ulU/mL



You should take all of your medications after eating, unless otherwise instructed. An exception to this rule is with thyroid medications, which should be taken on an empty stomach, at least one hour before eating or drinking anything besides water.

Additionally, because some psychiatric medications may increase your appetite, it is crucial that you eat a healthy diet and exercise in order to prevent weight gain.

Patient self-monitoring

At each appointment, Tim administers two psychological tests to measure depression and anxiety levels. If you are interested, you can keep track of your depression and anxiety scores over time. Tim charts these in an Excel spreadsheet. If you are interested in seeing your current and previous test scores, as well as your vital signs (weight, blood pressure, and heart rate), ask Tim for a copy of this spreadsheet. He can print one for you to take with you.

Optimum test scores are as follows (the lower, the better):

Depression 4 or less
Anxiety 4 or less
PTSD 50 or less