Lithium Addition in Endogenous Depressions Resistant to Tricyclic Antidepressants or Related Drugs: Relation to the Status of the Pituitary-Thyroid Axis

Schöpf, Josef; Lemarchand, T.

doi:10.1055/s-2007-1014304

Cited by 8 publications

(3 citation statements)

References 6 publications

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“…Schopf and Lemarchand [78] measured TSH, TRH-induced TSH, T4, free T4, T3 and free T3 before and a week after lithium augmentation. During this treatment TSH and delta TSH increased whereas FT3 and FT4 were decreased indicating a slight lithium-induced hyperthyroid function.…”

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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“…Lithium is mainly associated with thyrostatic effects leading to goitre and clinical hypothyroidism, which has fi rst been described in the late 1960s and early 1970s [3,10] (for review [1] ). A lowering effect on thyroid hormones by lithium has also been observed during lithium augmentation in patients with depression [9] . Lithium exposure might lead to an exacerbation of pre-existing autoimmune thyroditis by yet unexplained mechanisms [7] .…”

Section: Introductionmentioning

confidence: 89%

Thyrotoxicosis after Iodine Contrast Medium Administration: Rapid Mood Swing to Mania and Subsequent Psychotic Depression in a Patient with Bipolar Disorder during Lithium Therapy

Arlt¹,

Burkhardt²,

Wiedemann³

2008

Pharmacopsychiatry

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Letter 163 18 Meltzer HY , Lee MA , Ranjan R , Mason EA , Cola PA . Relapse following clozapine withdrawal: effect of neuroleptic drugs and cyproheptadine . Psychopharmacology (Berl) 1996 ; 124 : 176 -187 19 Moncrieff J . Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse . Acta Psychiatr Scand 2006 ; 114 : 3 -13 20 Moncrieff J . Why is it so diffi cult to stop psychiatric drug treatment? It may be nothing to do with the original problem . Med Hypotheses 2006 ; 67 : 517 -523 21 Suzuki T , Uchida H , Tanaka KF , Tomita M , Tsunoda K , Nomura K et al . Reducing the dose of antipsychotic medications for those who had been treated with high-dose antipsychotic polypharmacy: an open study of dose reduction for chronic schizophrenia . Int Clin Psychopharmacol 2003 ; 18 : 323 -329 22 Tollefson GD , Dellva MA , Mattler CA , Kane JM , Wirshing DA , Kinon BJ . Controlled, double-blind investigation of the clozapine discontinuation symptoms with conversion to either olanzapine or placebo. The Collaborative Crossover Study Group . J Clin Psychopharmacol 1999 ; 19 : 435 -443 23 Verghese C , Leon J De , Nair C , Simpson GM . Clozapine withdrawal effects and receptor profi les of typical and atypical neuroleptics . Biol Psychiatr 1996 ; 39 : 135 -138 24 Viguera AC , Baldessarini RJ , Hegarty JD , Kammen DP van , Tohen M . Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment .Interactions between lithium treatment and thyroid function are well known and the risk of hypothyroidism is widely recognized by clinicians. In addition, a higher presence of thyroid antibodies has been described in bipolar disorders independent of lithium exposure. We present a case of severe thyrotoxicosis with a rapid mood swing to mania and subsequent psychotic depression in a 56-year-old woman with bipolar disorder during lithium therapy following the administration of iodine contrast medium. On the basis of this case report and existing literature it seems advisable to closely monitor not only thyroid hormones but also thyroid antibodies in patients with bipolar disorders.

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“…[187] It is hypothesized that the mechanism of action of lithium augmentation to enhance antidepressant effects involves the hypothalamicpituitary-thyroid axis. Schopf and Lemarchand [232] observed a slight lithium-induced hypothyroid function and concluded that a sufficient T3 concentration is necessary for an optimal response to lithium addition. Rybakowski and colleagues [233] reported a decrease of both T4 and cortisol levels in lithium responders, pointing to a modulation of hormone levels along the hypothalamic-pituitary-thyroid axis.…”

Section: Lithiummentioning

confidence: 99%

Therapeutic Options for Treatment-Resistant Depression

Shelton

Osuntokun

Heinloth³

et al. 2010

CNS Drugs

186

137

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Treatment-resistant depression (TRD) presents major challenges for both patients and clinicians. There is no universally accepted definition of TRD, but results from the US National Institute of Mental Health's (NIMH) STAR*D (Sequenced Treatment Alternatives to Relieve Depression) programme indicate that after the failure of two treatment trials, the chances of remission decrease significantly. Several pharmacological and nonpharmacological treatments for TRD may be considered when optimized (adequate dose and duration) therapy has not produced a successful outcome and a patient is classified as resistant to treatment. Nonpharmacological strategies include psychotherapy (often in conjunction with pharmacotherapy), electroconvulsive therapy and vagus nerve stimulation. The US FDA recently approved vagus nerve stimulation as adjunctive therapy (after four prior treatment failures); however, its benefits are seen only after prolonged (up to 1 year) use. Other nonpharmacological options, such as repetitive transcranial stimulation, deep brain stimulation or psychosurgery, remain experimental and are not widely available. Pharmacological treatments of TRD can be grouped in two main categories: 'switching' or 'combining'. In the first, treatment is switched within and between classes of compounds. The benefits of switching include avoidance of polypharmacy, a narrower range of treatment-emergent adverse events and lower costs. An inherent disadvantage of any switching strategy is that partial treatment responses resulting from the initial treatment might be lost by its discontinuation in favour of another medication trial. Monotherapy switches have also been shown to have limited effectiveness in achieving remission. The advantage of combination strategies is the potential to build upon achieved improvements; they are generally recommended if partial response was achieved with the current treatment trial. Various non-antidepressant augmenting agents, such as lithium and thyroid hormones, are well studied, although not commonly used. There is also evidence of efficacy and increasing use of atypical antipsychotics in combination with antidepressants, for example, olanzapine in combination with fluoxetine (OFC) or augmentation with aripiprazole. The disadvantages of a combination strategy include multiple medications, a broader range of treatment-emergent adverse events and higher costs. Several experimental pharmaceutical treatment alternatives for TRD are also being explored in combination with antidepressants or as monotherapy. These less studied alternative compounds include pindolol, inositol, CNS stimulants, hormones, herbal supplements, omega-3 fatty acids, S-adenosyl-L-methionine, folic acid, lamotrigine, modafinil, riluzole and topiramate. In summary, despite an increasing variety of choices for the treatment of TRD, this condition remains universally undefined and represents an area of unmet medical need. There are few known approved pharmacological agents for TRD (aripiprazole and OFC) and overall outcomes rema...

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Lithium Addition in Endogenous Depressions Resistant to Tricyclic Antidepressants or Related Drugs: Relation to the Status of the Pituitary-Thyroid Axis

Cited by 8 publications

References 6 publications

Treatment-Resistant Depression

Treatment-Resistant Depression

Thyrotoxicosis after Iodine Contrast Medium Administration: Rapid Mood Swing to Mania and Subsequent Psychotic Depression in a Patient with Bipolar Disorder during Lithium Therapy

Therapeutic Options for Treatment-Resistant Depression

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