Acute Antidepressive Efficacy of Lithium Monotherapy, Not Citalopram, Depends on Recurrent Course of Depression

Bschor, Tom; Uhr, Manfred; Baethge, Christopher; Lewitzka, Ute; Ising, Marcus; Erbe, Sebastian; Winkelmann, Patricia; Ritter, Dirk

doi:10.1097/jcp.0b013e31827b9495

Cited by 13 publications

(9 citation statements)

References 26 publications

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“… CI: confidence interval; na: information not available. All trials were double-blind except Bschor et al (2013). a Response is decrease in Hamilton Depression Rating Scale (HDRS) score >50% by Watanabe et al (1975) and Bschor et al (2013); and as ⩾2 points improvement in the Bunney-Hamburg global rating scale (Bunney and Hamburg, 1963) after lithium administration by Baron et al (1975). b Overall difference in improvement does not differ ( t =0.10, p =0.54), but only one trial (Khan et al, 1987) provided outcome data for lithium vs placebo, leaving it ambiguous whether lithium and antidepressants had similar effects or both were ineffective overall. …”

Section: Resultsmentioning

confidence: 99%

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Lithium treatment for unipolar major depressive disorder: Systematic review

et al. 2019

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Background: The potential value of lithium treatment in particular aspects of unipolar major depressive disorder remains uncertain. Methods: With reports of controlled trials identified by systematic searching of Medline, Cochrane Library, and PsycINFO literature databases, we summarized responses with lithium and controls followed by selective random-effects meta-analyses. Results: We identified 36 reports with 39 randomized controlled trials: six for monotherapy and 12 for adding lithium to antidepressants for acute major depression, and 21 for long-term treatment. Data for monotherapy of acute depression were few and inconclusive. As an adjunct to antidepressants, lithium was much more effective than placebo (p<0.0001). For long-term maintenance treatment, lithium was more effective than placebo in monotherapy (p=0.011) and to supplement antidepressants (p=0.038), and indistinguishable from antidepressant monotherapy. Conclusions: The findings indicate efficacy of lithium as a treatment for some aspects of major depressive disorder, especially as an add-on to antidepressants and for long-term prophylaxis. It remains uncertain whether some benefits of lithium treatment occur with many major depressive disorder patients, or if efficacy is particular to a subgroup with bipolar disorder-like characteristics or mixed-features.

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Section: Resultsmentioning

confidence: 99%

“… a Response is decrease in Hamilton Depression Rating Scale (HDRS) score >50% by Watanabe et al (1975) and Bschor et al (2013); and as ⩾2 points improvement in the Bunney-Hamburg global rating scale (Bunney and Hamburg, 1963) after lithium administration by Baron et al (1975). …”

Section: Resultsmentioning

confidence: 99%

Lithium treatment for unipolar major depressive disorder: Systematic review

et al. 2019

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“…Furthermore, lithium has been recommended for the treatment of acute mania and for the augmentation of antidepressants in unipolar depression (Katona 1995 ; Bauer et al 2014 ). Its effectiveness as an antidepressant when used alone has been disputed (Bauer et al 2006 ; Bschor et al 2013 ). This review focuses on the use of lithium to prevent mood episodes in bipolar disorders.…”

Section: Introductionmentioning

confidence: 99%

Lithium for prevention of mood episodes in bipolar disorders: systematic review and meta-analysis

Severus

Taylor

Sauer

et al. 2014

Int J Bipolar Disord

176

133

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BackgroundIn a previous meta-analysis of randomized controlled trials comparing lithium with placebo as a long-term treatment in bipolar disorders, we observed a clear preventative effect for manic episodes; however, the effect was equivocal for depressive episodes. Since then, the evidence base has grown further. In this update, we furthermore present the data on efficacy of lithium in comparison to alternative drug treatments. In addition, we analyze the data comparing lithium with placebo and other treatments regarding drop-outs due to reasons other than a mood episode and completion of study (no mood episode and no drop-out to reasons other than a mood episode).MethodsRandomized controlled trials (RCTs) were sought comparing lithium with placebo and lithium with an alternative treatment in bipolar disorders where the stated intent of treatment was prevention of mood episodes. To this purpose, the Cochrane Central Register of Controlled Trials (CENTRAL) was searched. Reference lists of relevant papers and major textbooks of mood disorders were examined. Authors, other experts in the field, and pharmaceutical companies were contacted for knowledge of suitable trials, published or unpublished.ResultsFor the comparison of lithium with placebo, seven trials (1,580 participants) were included. Lithium was more effective than placebo in preventing overall mood episodes (random effects RR 0.66, 95% CI 0.53 to 0.82), manic episodes (random effects RR 0.52, 95% CI 0.38 to 0.71), and, dependent on the type of analyses applied, depressive episodes (random effects RR 0.78, 95% CI 0.59 to 1.03; fixed effect RR 0.73, 95% CI 0.60 to 0.88). Lithium was inferior to placebo in leading to drop-outs for reasons other than a mood episode (random effects RR 1.33, 95% CI 1.07 to 1.65) but superior to placebo on study completion (random effects RR 1.69, 95% CI 1.12 to 2.55).For the comparison of lithium with anticonvulsants, seven trials were included (n = 1,305). In prevention of manic episodes, lithium showed superiority compared to anticonvulsants (random effects RR 0.66, 95% CI 0.44 to 1.00). However, there was no significant difference regarding prevention of overall mood episodes, depressive episodes, dropping-out to reasons other than a mood episode, or study completion.ConclusionsThe evidence base for lithium in the long-term treatment of bipolar disorders has strengthened. With no other drug available having such ample and consistent evidence for its efficacy lithium remains the most valuable treatment option in this indication.

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“…Adjunctive lithium therapy is useful for treating refractory major depression, and clinical trials support its efficacy in combination with tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), tetracyclics and monoamine oxidase inhibitors (MAOIs) [30][31][32]. Patients with treatment-resistant depression are more likely to respond to lithium augmentation if they possess a family history of bipolar or unipolar depression, and if they have a history of more than three previous episodes of depression [33,34]. In practice, lithium can be added to any antidepressant, whereas combination therapies with other agents are often complicated.…”

Section: Unipolar Depression Acute Depressionmentioning

confidence: 99%

Current Status of Lithium in the Treatment of Mood Disorders

Malhi

McAulay

Fritz

2014

Curr Treat Options Psych

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Mood stabilizer I Bipolar disorder I Unipolar depression I Suicide I Prophylaxis I Neuroprotection I Dementia Opinion statement Arguably, lithium is the only true mood stabilizer and the only medication developed specifically for the treatment of bipolar disorder. Providing effective longterm prophylaxis, in addition to efficacy in acute treatment of mania and bipolar depression, lithium remains a valuable first-line therapeutic choice. Up to a third of patients on lithium treatment achieve complete remission for up to a decade, markedly countering the burden exacted by the illness. Its clinical use also extends to adjunctive therapy as an augmentation strategy in the management of major depression, dysthymia and cyclothymia; contexts within which its uniquely anti-suicidal properties are apposite. Despite these advantages and a burgeoning body of both empirical and scientific research establishing its efficacy, the clinical use of lithium has diminished in recent years because of displacement by newer agents and erroneous concerns regarding long-term side effects and potential for toxicity. Currently, lithium is experiencing a resurgence of interest as researchers attempt to understand its mechanisms of action and better define its clinical efficacy. This paper briefly reviews its current status with respect to the treatment of mood disorders, and argues that its prominent positioning in clinical practice guidelines worldwide is absolutely justified.

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Acute Antidepressive Efficacy of Lithium Monotherapy, Not Citalopram, Depends on Recurrent Course of Depression

Cited by 13 publications

References 26 publications

Lithium treatment for unipolar major depressive disorder: Systematic review

Lithium treatment for unipolar major depressive disorder: Systematic review

Lithium for prevention of mood episodes in bipolar disorders: systematic review and meta-analysis

Current Status of Lithium in the Treatment of Mood Disorders

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