The efficacy of lithium in prophylaxis of unipolar depression: evidence from its discontinuation

Article Abstract:

Forty patients diagnosed with clinical unipolar depression who discontinued using lithium (group A) were compared with 105 similar patients who continued taking the drug (group B). Patients (104 females, 41 males) were middle aged, and had, on average, three or more admissions to a psychiatric hospital for depression before ever starting lithium. No demographic differences were found between group A and group B. Outcome was determined by time elapsed between discharge from the hospital and next readmission. Time to readmission was analyzed using a life-table divided into two phases. In phase I, both groups were on lithium for a comparable time. Phase II was a two-year period in which group A discontinued the lithium, while group B continued to take it. The life-table analysis demonstrated that the probability of being well after two years of taking lithium was significantly higher in group A, so that discontinuation was strongly associated with successful treatment. Patients in group A who stopped taking lithium seemed to be those who were deriving the most benefit from it. However, there was a significantly worse outcome for group A in probability of remaining well for two years after stopping lithium (42 percent) compared with the probability of remaining well after two years for patients in group B (57 percent). Since group A showed no excess of recurrence in the first three months of phase II, their admissions were not purely the result of lithium withdrawal. The findings were thought to provide evidence for the prophylactic effect of lithium in unipolar depression. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Lithium treatment and prophylaxis in unipolar depression: a meta-analysis

Article Abstract:

Results of studies examining the efficacy of lithium in the treatment of depression have been inconsistent and difficult to interpret. In order to better evaluate these results, a meta-analysis was carried out. Meta-analysis is a method of review which employs quantitative techniques to combine the results of different studies and trials. By using large prospective clinical studies and then pooling the results of small, similar trials, the evaluation of treatment effects is made more feasible. Data for this meta-analysis were gathered from all published trials (in English) which compared lithium to other treatments for depression. Data analysis revealed that longitudinal studies which compared lithium with placebo, other well established antidepressants, and the amino acid tryptophan demonstrated a very moderate advantage for lithium. Prospective and longitudinal trials of lithium versus placebo used prophylactically to prevent relapse of depression demonstrated a highly significant effect for lithium. However, lithium was not found to be more advantageous than traditional antidepressant medication. Treatment for active depression by lithium alone remains questionable. In most cases, depression was best relieved by traditional antidepressant treatment (e.g., tricyclics) with or without lithium. The major finding of the meta-analysis was that once the acute episode of depression has been stabilized, the use of lithium to maintain stability for recurrent depression is supported. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Lithium augmentation in antidepressant-resistant patients: a quantitative analysis

Article Abstract:

Ten percent or more of patients with depression do not respond to treatment despite repeated attempts at treatment with antidepressant medication. This is a serious clinical problem known as treatment-resistant depression. Often treatment-resistant depressives are offered a drug to amplify the effects of the prescribed antidepressant. A variety of drugs, such as L-tryptophan, assorted stimulants, and reserpine, have been used for this, but lithium carbonate has achieved the most promising results. The present study was designed to gather data from known controlled trials of lithium augmentation, of which there are relatively few, in antidepressant-resistant patients. The data were pooled and subjected to statistical analysis, or meta-analysis, to determine the overall effect that lithium seemed to have. This analysis revealed a highly significant effect of lithium in treating treatment-resistant depression across these studies. Specifically, the odds of treatment-resistive depressives remaining depressed after lithium was offered with the standard antidepressant were 56 to 95 percent lower. Overwhelming support was lent, therefore, to the notion that lithium can successfully augment the action of antidepressants in treatment-resistant patients. The duration of treatment necessary to achieve the desired effect needs to be further investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antidepressants, Lithium carbonate

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