Combining lithium and neuroleptic is useful in treatment of bipolar disorder. However, encepatholapthy can be anticipated to result when lithium is used with high potency anti-psychotic such as haloperidol and risperidone and there are baseline EEG abnormalities.

To the Editor: Refractory depression is common in clinical practice. At least 30% of patients fail to respond to initial antidepressant therapy. 1 In patients who have failed 1 course of antidepressants, there is evidence from 9 randomized controlled trials suggesting that approximately 50% of treatment-refractory patients do respond to lithium augmentation compared with placebo (p < .001). 2 The British Association for Psychopharmacology guidelines recommend that patients be treated with 2 antidepressants before an augmentation strategy is used. 3 Our aim was to review the evidence for use of lithium in those patients who are resistant to treatment with 2 or more antidepressants at recognized therapeutic doses. Method.A systematic review was undertaken of placebo-controlled, double-blind, randomized trials of lithium that assess its effectiveness in treatment-resistant depression. English-language studies of adults (aged 18 years or older; both sexes), suffering from major depressive disorder diagnosed by the International Classification of Diseases,

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Neuroleptic treatment in schizophrenic patients has been associated with sexual dysfunction, including impotence and decreased libido. Spontaneous ejaculation without sexual arousal during typical antipsychotic treatment is a rare condition that has been described with zuclopentixol, trifluoperazine, and thiothixene. Here, we are reporting a case of spontaneous orgasm with ziprasidone in a bipolar patient. This patient began to repeatedly experience spontaneous sexual arousal and orgasm, which she had never experienced in the past. Ziprasidone might be causing an increase in sexual orgasm by 5-HT2 receptor antagonism, which preclinical evidence suggests that it facilitates dopamine release in the cortex.