Treatment of Depressions Resistant to Tricyclic Antidepressants, Related Drugs or MAO-Inhibitors by Lithium Addition: Review of the Literature

Schöpf, Josef

doi:10.1055/s-2007-1014602

Cited by 33 publications

(10 citation statements)

References 28 publications

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“…When the placebo was replaced by lithium in a blind fashion, all these patients showed improvement in a week. In a double-blind study, 13 patients received placebo and 14 received lithium carbonate 800 mg daily in addition to their antidepressant regimen [69]. A significant difference in the Hamilton Depression Rating score was noted between the two groups at the end of 1 week.…”

Section: Treatmentmentioning

confidence: 99%

Treatment-Resistant Depression

Ananth

1998

Psychother Psychosom

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Our ability to treat depression has improved with the availability of receptor-specific and chemically diverse groups of antidepressants. Even now, most of the short-term studies indicate that about 20% of depressed patients remain resistant to treatment. Therefore, it is important to properly assess the treatment-resistant depressed (TRD) patients and to separate the truly refractory patients from those inadequately treated. Undiagnosed medical conditions should be eliminated. TRD is neither a clinically nor a biologically identifiable entity. As there are no established methods for the treatment of TRD, all options should be considered. The clinician can be enriched by the knowledge of the treatment modalities available, and yet, in treating an individual patient, clinical skills, intuitive judgment, family history of response to drugs and side effects, all play a vital role. Several of the approaches described in the paper indicate available methods and their merits in general but there is no way of ascertaining by which particular method a patient should be treated. The three common methods of treatment are substitution of one antidepressant drug for another, combination therapies and augmentation techniques. These are based on clinical experiences and not research findings. Therefore the treatment of TRD patients is more an art than a science. The physician should assess all the psychopathological, phenomenological and psychosocial variables to appropriately treat an individual patient.

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Section: Treatmentmentioning

confidence: 99%

Treatment-Resistant Depression

Ananth

1998

Psychother Psychosom

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“…The time to response after lithium is added to a TCA appears to be variable (Price et al, 1986), varying from 48 hours (DeMontigny et al, 1981) to 2 weeks (Schopf, 1989). These studies have tended to be uncontrolled.…”

Section: "Treatment-resistant'' Depressionmentioning

confidence: 99%

Clinical and biochemical aspects of depressive disorders: III. Treatment and controversies

Caldecott-Hazard

Schneider

1992

Synapse

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The present document is the final of three parts of a review that focuses on recent data from clinical and animal research concerning the biochemical bases of depressive disorders, diagnosis, and treatment. Various treatments for depression, including psychotherapy, pharmacological, and somatic treatments, will be described in this third part. Also, some of the controversies in the field, as well as a summary of the most salient points of the review, will be discussed. Previous sections of this review dealt with the classification of depressive disorders and research techniques for studying the biochemical mechanisms of these disorders (Part I) and various transmitter/receptor theories of depressive disorder (Part II).

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“…In the general adult population, all double-blind studies of lithium augmentation reporting benefits of lithium over placebo have used plasma levels of 0.5 mmol/l or greater. Several investigators have found that above this level there is no correlation between the plasma level and clinical improvement (Heninger et al, 1983;Schopf, 1989). The only study to compare low dose to high dose lithium found that 250 mg per day (plasma level of 0.25 mmol/l) prescribed for 3 weeks was no more effective than placebo but that 750 mg per day (0.78 mmol/l) was significantly more effective than the lower dose (Stein and Bernadt, 1993).…”

Section: Lithiummentioning

confidence: 98%

Augmentation strategies in geriatric depression

Flint¹

1995

Int J Geriat Psychiatry

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SUMMARYApproximately 3040% of elderly patients with major depression have inadequate response to an initial therapeutic trial of antidepressant medication. In these cases augmentation of the antidepressant has been recommended as one way of improving the rate of response. This article reviews the literature on augmentation strategies in treatmentresistant geriatric depression. Successful augmentation with lithium, triiodothyronine, stimulants, carbamazepine, valproate and a tricyclic-serotonin reuptake inhibitor combination have been described. However, there have been no controlled trials and, with the exception of two open prospective studies of lithium potentiation, the literature consists entirely of case reports and retrospective case series. As a result, it is difficult to draw conclusions about the efficacy of these strategies in late life, especially since treatment failures seldom get reported. Side-effects may limit the usefulness of some augmentation regimens in old age-up to 25% of patients treated with lithium or carbamazepine discontinued these medications because of adverse events. There is a need for controlled studies to better determine the clinical utility of augmentation strategies in physically well depressed elderly, as well as those with depression complicating medical illness, dementia and other neurological disorders.

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Treatment of Depressions Resistant to Tricyclic Antidepressants, Related Drugs or MAO-Inhibitors by Lithium Addition: Review of the Literature

Cited by 33 publications

References 28 publications

Treatment-Resistant Depression

Treatment-Resistant Depression

Clinical and biochemical aspects of depressive disorders: III. Treatment and controversies

Augmentation strategies in geriatric depression

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