Lithium augmentation therapy in refractory depression?Update 2002

Abstract

Lithium has been used to augment the efficacy of antidepressant medications for more than 20 years. The present study examines whether evidence exists to support the clinical efficacy of lithium augmentation in refractory, treatment resistant depression. Studies were identified by searching Medline (1980 to August 2002) and by scanning the references of published reviews and standard textbooks. Studies were selected if they were open-labeled or double-blind, placebo-controlled or comparator trials that involved patients who had not responded to conventional antidepressants. 27 prospective studies were identified that included a total of 803 depressed patients displaying the following designs: 10 double-blind, placebo-controlled trials, 2 randomized, double-blind comparator trials, 2 randomized, open comparator trials, and 13 open-label trials. The majority of randomized controlled trials has demonstrated substantial efficacy of lithium augmentation in partial and non responders to antidepressant treatment. In the placebo-controlled trials, the response rate in the lithium group was 45% and in the placebo group 18% (p<0.001). Summarizing all open and controlled studies, approximately 50% of patients responded to lithium augmentation within 4 weeks. In conclusion, lithium is the foremost and most well-documented augmentation strategy in refractory depression.Therefore, it should be considered a first-line treatment strategy in patients with major depression who do not adequately respond to standard antidepressants.

Glycogen Synthase Kinase-3: a Putative Molecular Target for Lithium Mimetic Drugs

“…However, lithium has clear utility as an adjunct antidepressant in treatment refractory patients (Heninger et al, 1983). Overall, in placebo-controlled trials, lithium has been found useful as an adjunct medication for 45% of patients (Bauer et al, 2003). Lithium also has antisuicidal effects, the molecular antecedents of which are of considerable interest (Baldessarini et al, 2001;Goodwin et al, 2003;Muller-Oerlinghausen, 2001).…”

The behavioral actions of lithium in rodent models: Leads to develop novel therapeutics

“…It has been shown to augment antidepressant effectiveness in treatment-refractory patients Austin et al, 1991). A recent review revealed that approximately 45% of patients monitored in placebo-controlled studies responded to lithium as an adjunct medication for depression (Bauer et al, 2003), a rate higher than for any other medication. Further, some studies have suggested that lithium monotherapy is an effective prophylactic agent in unipolar depressed patients (see for meta-analysis and review).…”

Involvement of AMPA receptors in the antidepressant-like effects of lithium in the mouse tail suspension test and forced swim test

“…Furthermore, lithium has clear utility as an adjunct antidepressant in treatment-refractory patients (de Montigny et al, 1983;Heninger et al, 1983). Overall, in placebo-controlled trials, lithium has been found useful as an adjunct medication for approximately 45% of patients (Bauer et al, 2003). However, it is unclear how the clinically relevant antidepressant actions of lithium are exerted.…”