Lithium carbonate augmentation of desipramine and fluoxetine in refractory depression

Fontaine, R.; Ontiveros, Alfonso; Elie, Robert; Vézina, M.

doi:10.1016/0006-3223(91)90062-q

Cited by 25 publications

(11 citation statements)

References 3 publications

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“…In the studies published on lithium augmentation in depression refractory to SSRIs, some authors define resistance by ªconsensus of authorsº [23] or as a failure to reduce HDRS scores by 50 % [12,97] ( Table 1). Other authors assume refractoriness where the score of the depression rating scales (Hamilton Depression Rating Scale HDRS, Montgomery Asberg Depression Rating Scale MADRS) remains above a fixed value [35,36,43,44,73] with the threshold itself again fluctuating considerably between studies. Some authors finally defined efficacy combining an HDRS score reduction of at least 50 % with post treatment scores above a fixed threshold [26,33].…”

Section: Definition Of Treatment Resistancementioning

confidence: 99%

“…In a study on 60 consecutive outpatients with major depressive disorder with melancholia (DSM-III-R) not responding to a 6week antidepressant treatment (³ 22 points in the 17-item HDRS), lithium carbonate was added at doses giving a lithium plasma level of 0.3 to 1.2 mEq/l [36]. Thirty of these patients had been treated with fluoxetine (20 ± 80 mg/day).…”

Section: Open Studiesmentioning

confidence: 99%

“…Unfortunately, results collected after 48 hours are not yet available for reviewed studies on lithium augmentation in SSRI resistant patients. However, five studies included evaluation after one week of augmentation [12,25,26,36,86,97] (Table 4). In most studies, about half of the patients with SSRI/lithium combinations had responded after one week.…”

Section: Latency Of Effectmentioning

confidence: 99%

See 2 more Smart Citations

Lithium Augmentation in Depressive Patients Not Responding to Selective Serotonin Reuptake Inhibitors1

Zullino¹,

Baumann²

2001

Pharmacopsychiatry

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This communication reviews current literature on lithium augmentation in patients not responding to SSRIs, giving some recommendations at the end. A significant proportion of depressive patients do not respond to a first antidepressive treatment independently of the class of drugs used. During the last 10 years, there have been several case reports published about open and controlled studies on the use of lithium augmentation in patients who were non-responders to SSRIs, including citalopram, fluoxetine, paroxetine and sertraline. The main underlying hypothesis is a synergistic effect between SSRIs and lithium, which both act on serotonergic neurotransmission. The available studies vary considerably in methodology. There are insufficient results available to confirm a rapid improvement (within 24-48h) after introduction of lithium, but most studies show substantial effects after 1 - 2 weeks, and some after 6 weeks. There is as yet no more clear evidence for a pharmacokinetic interaction between lithium and SSRIs with pharmacodynamic consequences. In conclusion, present evidence suggests that a lithium augmentation in depressive patients who do not respond to SSRIs may be an efficacious and generally well tolerated treatment, with a response rate of at least 50% after a period lasting 1 - 2 weeks. However, special care is indicated when treating elderly patients, where the risk of adverse effects is higher.

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Section: Definition Of Treatment Resistancementioning

confidence: 99%

Section: Open Studiesmentioning

confidence: 99%

Section: Latency Of Effectmentioning

confidence: 99%

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Lithium Augmentation in Depressive Patients Not Responding to Selective Serotonin Reuptake Inhibitors1

Zullino¹,

Baumann²

2001

Pharmacopsychiatry

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“…In older patients successful lithiumpotentiation has also been reported with MAOIs, SSRIs, trazadone and tetracyclics (Lafferman et al, 1988;Katona and Finch, 1991;Yoshimura et al, 1992;Flint and Rifat, 1994). Interestingly, Fontaine et al (1991) found that although there was no difference between patients on desipramine or fluoxetine in their initial response to adjunctive lithium, by the end of 14 weeks of augmentation one-third of the fluoxetine responders had relapsed compared with none of the desipramine responders. This raises the possibility of differential effects between serotonergic and noradrenergic antidepressants in the chronic stages of augmentation.…”

Section: Lithiummentioning

confidence: 99%

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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“…Mork et a1 (1989) showed that combining lithium and imipramine redud b e t a -N A sensitivity in rat cerebral cortex more than did either drug alone. Fluoxetine is a 5-HT reuptake blocker (Schmidt et al, 1988) which desensitizes presvnaptic autoreceptors (Blier et al, 1990) ; it too is augmented by lithium (Fontaine et al, 1991) . This suggests an additional mechanism whereby 5-HT activity may be enhanced.…”

Section: Intrcductionmentioning

confidence: 99%

Failure of Addition of Lithium to Imipramine to Enhance Activity in Rats or Mood in Normal Volunteers

Benjamin

Belmaker

Berzovsky

et al. 1992

Pharmacology & Toxicology

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Lithium powerfully augments the effects of imipramine in resistant depression. We treated four groups of rats for five weeks with (1) saline alone, (2) saline followed by lithium, (3) imipramine alone, and (4) imipramine followed by lithium. There was no augmentation of activity by lithium. Normal human volunteers took imipramine 75 mg daily for three weeks, followed by imipramine 75 mg daily together with lithium 900 mg daily for another ten days. There was no elevation of mood after the addition of lithium. Lithium augmentation of antidepressants apparently requires a pre-existing neurochemical-behavioral disturbance.

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Lithium carbonate augmentation of desipramine and fluoxetine in refractory depression

Cited by 25 publications

References 3 publications

Lithium Augmentation in Depressive Patients Not Responding to Selective Serotonin Reuptake Inhibitors1

Lithium Augmentation in Depressive Patients Not Responding to Selective Serotonin Reuptake Inhibitors1

Augmentation strategies in geriatric depression

Failure of Addition of Lithium to Imipramine to Enhance Activity in Rats or Mood in Normal Volunteers

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