Comparative efficacy of lithium and amitriptyline in the maintenance treatment of recurrent unipolar depression: a randomised study

Greil, Waldemar; Ludwig‐Mayerhofer, Wolfgang; Erazo, Natalia; Engel, Rolf R.; Czernik, Adelheid; Giedke, H.; Müller‐Oerlinghausen, B.; Osterheider, Michael; Rudolf, G. A. E.; Sauer, Heinrich; Tegeler, J.; Wetterling, Tilman

doi:10.1016/0165-0327(96)00070-5

Cited by 74 publications

(31 citation statements)

References 30 publications

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“…The antidepressant effects of high serum lithium levels are not surprising in view of the considerable literature suggesting an antidepressant effect of lithium in bipolar depression and to a lesser extent in unipolar depression and depression associated with schizoaffective disorder (6,(26)(27)(28).…”

Section: Discussionmentioning

confidence: 96%

Double-Blind, Placebo-Controlled Comparison of Imipramine and Paroxetine in the Treatment of Bipolar Depression

Nemeroff¹,

Evans²,

Gyulai³

et al. 2001

AJP

356

148

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Section: Discussionmentioning

confidence: 96%

Double-Blind, Placebo-Controlled Comparison of Imipramine and Paroxetine in the Treatment of Bipolar Depression

Nemeroff¹,

Evans²,

Gyulai³

et al. 2001

AJP

356

148

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“…To make sure that the results do not depend on the specific definition of a treatment failure, different failure criteria were formulated for statistical analyses (for details see Greil et al [32]): (1) hospitalization, (2) recurrence, (3) recurrence and/or concomitant psychotropic medication (antidepressants and/or neuroleptics) for at least 6 months, (4) recurrence and/or concomitant psychotropic medication and/or side effects prompting discontinuation of treatment and (5) recurrence and/or subclinical recurrence. In the present paper, data are presented with respect to hospitalization, but we always indicate whether the results depend on the way efficacy has been analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…However, if concomitant medication was judged to be inevitable, it was accepted and documented. A detailed description of the study design is given in Greil et al [31,32]. Following a polydiagnostic approach, patients were diagnosed not only according to ICD-9 but also according to DSM-III-R using the Structured Clinical Interview of Mental Disorders and according to RDC [33].…”

Section: Methodsmentioning

confidence: 99%

Differential Efficacy of Lithium and Carbamazepine in the Prophylaxis of Bipolar Disorder: Results of the MAP Study

Kleindienst¹,

Greil

2000

Neuropsychobiology

105

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In a randomized clinical trial with an observation period of 2.5 years, the differential efficacy of lithium versus carbamazepine was compared in 171 bipolar patients (DSM-IV). In order to investigate the efficacy of the two drugs in clearly defined subsamples, a series of subgroup analyses was carried out. First, patients with a bipolar I disorder (n = 114) were analyzed separately. In these patients, lithium was superior to carbamazepine. In contrast, carbamazepine was at least equally as efficacious as lithium in the subsample of patients with bipolar II disorder or bipolar disorder not otherwise specified (n = 57). In a second analysis on differential efficacy, the whole sample was subdivided into a classical subgroup (bipolar I patients without mood-incongruent delusions and without comorbidity; n = 67) and a nonclassical subgroup including all other patients (n = 104). Classical bipolar patients had a significantly lower hospitalization rate under lithium than under carbamazepine prophylaxis (26 vs. 62%, p = 0.012). For the nonclassical group, a tendency in favor of carbamazepine was found. In a third step, we analyzed the impact of episode sequence on differential efficacy. In a global view, the episode sequence prior to the index episode was not correlated to differential efficacy. Our results might, however, indicate that patients with an episode sequence of mania-depression-free interval responded better to lithium. Besides differential efficacy, suicidal behavior and patients’ satisfaction with treatment were investigated. Regarding suicidal behavior, a trend in favor of lithium was found. The data on patients’ satisfaction were significantly in favor of carbamazepine. In conclusion, lithium appears to be superior to carbamazepine in classical bipolar cases and might have additional impact on proneness to suicide. The distinctly larger group of patients with nonclassical features might profit more from carbamazepine which seems to be well accepted by the patients. Hence, treatment alternatives to lithium are desirable for the majority of bipolar patients.

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“…Further evidence suggests that lithium also prevents depressive recurrences in bipolar patients. Significant superiority over placebo in one study ) is corroborated by a couple of underpowered studies showing a clear trend in favor of lithium (e. g., Cundall et al 1972;Persson 1972) and several studies showing lithium to prevent depression in unipolar depression (e. g., Persson 1972;Coppen et al 1978;Kane et al 1982;Greil et al 1996). The latter studies give strong indirect support for lithium preventing bipolar depression, especially as many of the patients formerly diagnosed as unipolar would be considered to belong to a bipolar spectrum according to recent research criteria (Angst 1998;Greil and Kleindienst in press).…”

Section: Alternative Mood-stabilizersmentioning

confidence: 86%

Lithium in the long-term treatment of bipolar disorders

Kleindienst¹,

Greil

2003

European Archives of Psychiatry and Clinical Neuroscience

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Usefulness of lithium in the prophylaxis of bipolar disorders has been challenged for five major reasons. The authors review the empirical basis of these criticisms and come to the following conclusions. 1. Lithium efficacy is high and beyond reasonable doubt in classic manic-depressive illness. Bipolar patients presenting atypical features show a much poorer response rate to lithium. 2. There is no empirical evidence for a loss of lithium efficacy over time. 3. There is little evidence for discontinuation-induced refractoriness to lithium. 4. Lithium withdrawal phenomena are well established but seem to be rather specific to certain subgroups. Withdrawal phenomena seem to be common in atypical bipolar disorder but rare in fully stabilized classic manic-depressive illness. 5. Other factors limiting lithium efficacy in clinical practice (e. g., non-compliance) are not specific to lithium. In conclusion, prophylactic lithium does have major drawbacks and there is a clear need for more efficacious alternatives in non-classic bipolars. Compared to existing alternatives, lithium currently is to be considered the golden standard. This status might, however, be challenged by major alternative mood-stabilizers that are presently under clinical investigation.

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Comparative efficacy of lithium and amitriptyline in the maintenance treatment of recurrent unipolar depression: a randomised study

Cited by 74 publications

References 30 publications

Double-Blind, Placebo-Controlled Comparison of Imipramine and Paroxetine in the Treatment of Bipolar Depression

Double-Blind, Placebo-Controlled Comparison of Imipramine and Paroxetine in the Treatment of Bipolar Depression

Differential Efficacy of Lithium and Carbamazepine in the Prophylaxis of Bipolar Disorder: Results of the MAP Study

Lithium in the long-term treatment of bipolar disorders

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