Lithium Augmentation in Antidepressant-Resistant Patients a Quantitative Analysis

1991 ◽  
Vol 159 (4) ◽  
pp. 510-514 ◽  
Author(s):  
M.-P. V. Austin ◽  
F. G. M. Souza ◽  
G. M. Goodwin
Keyword(s):  
Quantitative Analysis ◽  
Odds Ratio ◽  
Lithium Treatment ◽  
Effect Sizes ◽  
Antidepressant Effect ◽  
Treatment Resistant ◽  
Duration Of Treatment ◽  
Considerable Uncertainty ◽  
Resistant Depression ◽  
Lithium Augmentation

A quantitative analysis was used to examine the efficacy of lithium augmentation in the acute treatment of depressed patients resistant to a standard trial of an antidepressant. Effect sizes were measured by the odds ratio using the Mantel–Haenszel method. Only controlled trials were included in order to minimise bias in method. A highly statistically significant effect for lithium augmentation was found, the pooled odds ratio being 0.146 and its 95% confidence interval 0.05–0.44 (i.e. the odds of remaining ill are reduced by between 56% and 95% with the use of lithium treatment). While these results support the case for lithium augmentation in treatment-resistant depression, there remains considerable uncertainty over the duration of treatment necessary to see and sustain the treatment response.

Lithium in Tricyclic-Resistant Depression Correlation of Increased Brain 5-HT Function with Clinical Outcome

1991 ◽  
Vol 159 (3) ◽  
pp. 341-346 ◽  
Author(s):  
P. J. Cowen ◽  
S. L. McCance ◽  
C. J. Ware ◽  
P. R. Cohen ◽  
J. S. Chalmers ◽  
...  
Keyword(s):  
Lithium Treatment ◽  
Antidepressant Medication ◽  
Tricyclic Antidepressant ◽  
Antidepressant Effect ◽  
Endocrine Response ◽  
Treatment Combination ◽  
Prolactin Release ◽  
Limited Support ◽  
Resistant Depression ◽  
Prolactin Response

The addition of lithium to the tricyclic antidepressant medication of 23 patients with major depression resulted in an increase in the prolactin response to intravenous l-tryptophan after both four days and four weeks of treatment. The extent of this increase did not distinguish the ten patients who were classified as clinical responders (> 50% reduction in score on the HRSD). Among the responders there was a modestly significant correlation between the decrease in score on the HRSD and the enhancement of tryptophan-induced prolactin release. Some responders, however, showed very little change in this endocrine response over the four weeks of lithium treatment. Lithium may increase brain 5-HT function in tricyclic-resistant depression but there is only limited support for the hypothesis that changes in brain 5-HT function are involved in the antidepressant effect of this treatment combination.

scholarly journals Resistant depression: criteria for determination, risk factors and therapeutic strategies

2017 ◽  
Vol 2 (3) ◽  
pp. 020338
Author(s):  
Olena Khaustova
Keyword(s):  
Risk Factors ◽  
Atypical Antipsychotics ◽  
Therapeutic Response ◽  
Therapeutic Strategies ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Duration Of Treatment ◽  
Resistance To Treatment ◽  
Step Model ◽  
Resistant Depression

Background Therapy of resistant depression raises a number of diagnostic and therapeutic problems, requires the solution of a number of methodological issues. A scientific discussion continues around the definition of depression resistance, assessment of the degree of reduction of depressive symptoms, the level of social and role functioning of patients; the improvement of models for determining the degree of resistance to various types of depression therapy continues; new methods of therapy and new algorithms of combined therapy are being developed. The ultimate goal of all these efforts should be practical recommendations for determining therapeutic options for the treatment of patients with resistant depression, which will help doctors make informed decisions on intervention strategies. Aim To analyze the therapeutic possibilities of treating depressive disorders that are resistant to therapy. Methods Publications from the Pubmed, MEDLINE, the Cochrane Library, Web of Science, Google Scholar databases were analyzed. Tags: depression, treatment, resistance, psevdoresistence, therapeutic response, resistance to treatment, strategies for treatment of resistant depression. Results The terminology related to resistant depression was defined: lack of a therapeutic response, adequate dose, adequate duration of treatment, antidepressant intolerance, pseudo-resistance, relative resistance to treatment, absolute resistance to treatment, treatment of resistant depression, remission, recovery. Models for determining the resistance of depression have been described: the Thase & Rush model; European stepped model; A step model of the Massachusetts hospital; Step model of Maudsley; Form of the history of treatment with antidepressants. Risk factors for treatment of resistant depression were identified, and the main therapeutic strategies were described: optimization, switching, augmentation, combination and non-drug therapy. Particular attention is paid to the use of atypical antipsychotics, in particular arapiprazole, as the augmentation strategy. A complex approach is described, which includes various combinations of the above strategies. Conclusion Each case of treatment-resistant depression has its own unique characteristics and requires careful evaluation to determine the correct diagnosis and the quality of the therapeutic response. Equally important for building an adequate treatment plan is evaluating risk factors for the treatment of resistant depression. There is a wide variety of options for the treatment of resistant depression, so each therapeutic strategy should be used to help patients with treatment-resistant depression. The combination of antidepressant therapy and atypical antipsychotics with antidepressant properties in combination with psychotherapeutic intervention and adherence to adequate doses and duration of treatment may be a choice strategy for patients with treatment-resistant depression.

Predictors of efficacy in lithium augmentation for treatment-resistant depression

2010 ◽  
Vol 125 (1-3) ◽  
pp. 165-168 ◽  
Author(s):  
Hiroko Sugawara ◽  
Kaoru Sakamoto ◽  
Tsuyoto Harada ◽  
Jun Ishigooka
Keyword(s):  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Lithium Augmentation

scholarly journals Transcranial pulsed electromagnetic fields for treatment-resistant depression: A multicenter 8-week single-arm cohort study

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
Erik Roj Larsen ◽  
Rasmus W. Licht ◽  
René Ernst Nielsen ◽  
Annette Lolk ◽  
Bille Borck ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antidepressant Treatment ◽  
Treatment Options ◽  
Depression Scale ◽  
Antidepressant Effect ◽  
Hamilton Depression Scale ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Pulsed Electromagnetic

Abstract Background. The efficacy of antidepressant treatment is fair, but the efficacy is considerably lower in patients failing two or more trials underscoring the need for new treatment options. Our study evaluated the augmenting antidepressant effect of 8-weeks transcranial pulsed electromagnetic field (T-PEMF) therapy in patients with treatment-resistant depression. Methods. A multicenter 8-week single-arm cohort study conducted by the Danish University Antidepressant Group. Results. In total, 58 participants (20 men and 38 women) with a moderate to severe depression as part of a depressive disorder according to ICD-10 who fulfilled criteria for treatment resistance were included, with 19 participants being nonresponders to electroconvulsive therapy during the current depressive episode. Fifty-two participants completed the study period. Scores on the Hamilton Depression Scale 17-items version (HAM-D17) decreased significantly from baseline (mean = 20.6, SD 4.0) to endpoint (mean = 12.6, SD 7.1; N = 58). At endpoint, utilizing a Last Observation Carried Forward analysis, 49 and 28% of those participants with, respectively, a nonchronic current episode (≤2 years; N = 33) and a chronic current episode (>2 years; N = 25) were responders, that is, achieved a reduction of 50% or more on the HAM-D17 scale. At endpoint, respectively, 30 and 16% obtained remission, defined as HAM-D17 ≤ 7. On the Hamilton Scale 6-item version (HAM-D6), respectively, 51 and 16% obtained remission, defined as HAM-D6 ≤ 4. Conclusions. The findings indicate a potential beneficial role of T-PEMF therapy as an augmentation treatment to ongoing pharmacotherapy in treatment-resistant depression.

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