{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T03:01:45Z","timestamp":1777863705039,"version":"3.51.4"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>Depression during pregnancy is common worldwide, with higher prevalences in low-income countries compared to high-income countries. Yet, current antidepressant dosing strategies in pregnant patients rarely account for the substantial pharmacokinetic shifts that occur. Altered hepatic metabolism and enhanced renal clearance can reduce plasma concentrations, potentially compromising efficacy. Therapeutic drug monitoring (TDM) offers one strategy: targeting plasma concentrations that correlate with adequate central nervous system (CNS) target engagement. Model-informed precision dosing (MIPD) takes this further, using population pharmacokinetic modelling to predict individualised doses. We examined prescribing patterns in an IRB-approved retrospective cohort and observed that dosing remained stable across trimesters despite reported pharmacokinetic alterations. This disconnect between emerging pharmacological knowledge and current practice deserves attention. Challenges remain such as assay availability is limited, there are fundamental cost considerations, and pregnancy-specific reference ranges need further development. Our position is that interdisciplinary collaboration should drive the growth of standardised protocols that integrate TDM and MIPD into prenatal care. Prospective trials will ultimately establish clinical benefit, but the mechanistic rationale already warrants systematic investigation.<\/jats:p>","DOI":"10.3389\/fphar.2026.1817244","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:30:15Z","timestamp":1777527015000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimising antidepressant therapy in pregnancy: a perspective on therapeutic drug monitoring and model-informed precision dosing"],"prefix":"10.3389","volume":"17","author":[{"given":"S\u00edlvia M.","family":"Illamola","sequence":"first","affiliation":[{"name":"Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen M.","family":"Job","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine","place":["Salt Lake City, UT, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela K.","family":"Birnbaum","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota","place":["Minneapolis, MN, United States"]},{"name":"Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine","place":["Salt Lake City, UT, United States"]},{"name":"Center for Clinical and Cognitive Neuropharmacology, College of Pharmacy, University of Minnesota","place":["Minneapolis, MN, United States"]},{"name":"Department of Medical Laboratory Sciences, College of Pharmacy, University of Minnesota","place":["Minneapolis, MN, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maged M.","family":"Costantine","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University","place":["Columbus, OH, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine M.","family":"Sherwin","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota","place":["Minneapolis, MN, United States"]},{"name":"Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine","place":["Salt Lake City, UT, United States"]},{"name":"Internal Medicine, UWA Medical School, The University of Western Australia","place":["Perth, WA, Australia"]},{"name":"Differentia Biotech Ltd","place":["South San Francisco, CA, United States"]},{"name":"Department of Pharmacology and Toxicology, Wright State University Boonshoft School of Medicine","place":["Dayton, OH, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1093\/jpp\/rgad106","article-title":"Precision dosing of venlafaxine during pregnancy: a pharmacokinetics modelling approach","volume":"76","author":"Alenezi","year":"2024","journal-title":"J. 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