Up to a third of elderly patients with major depressive disorder do not respond to a first course of treatment with an antidepressant. There is a lack of controlled studies evaluating therapies for treatment-resistant depression in late-life depression, and no randomized controlled studies assessing the efficacy and tolerability of lithium augmentation in elderly patients have been published.
Twenty-nine elderly inpatients with major depressive disorder according to DSM-IV criteria who had previously failed to respond to 1 or more adequate trials with a tricyclic antidepressant or venlafaxine were included in a 6-week, open, randomized, controlled study with a 2-year follow-up. Subjects received either lithium augmentation or the monoamine oxidase inhibitor phenelzine. The primary outcome criterion was remission, defined as a final score of less than or equal to 10 on the Montgomery-Asberg Depression Rating Scale (MADRS). Response was defined as at least 50% reduction on the MADRS or the Hamilton Rating Scale for Depression (HAM-D).
Twenty-eight subjects completed the trial. Remission on the MADRS was achieved by 33.3% of the lithium patients, compared with none of the phenelzine patients (p = .042). Response also showed a difference in favor of lithium augmentation (p = .035 on both the MADRS and the HAM-D). Overall tolerability was good, with no dropouts due to side effects. Subjective memory impairment was more prevalent among patients receiving phenelzine (p = .002), and tremors were significantly more prevalent among patients receiving lithium (p = .002). During the 2-year follow-up, 25 patients (86.2%) did achieve remission, particularly on prolonging the lithium treatment (5 patients) or on lithium augmentation to phenelzine (5 patients).
Lithium was more effective than phenelzine in elderly patients with treatment-resistant major depressive disorder, while tolerance of both treatments was remarkably good in this group of elderly inpatients with many comorbid medical disorders.
Controlled-trials.com identifier is RCTN93105957.
"In contradiction, one suicide has been reported in the lithium treatment group within a double-blind period and one suicide in an open-label phase of a 12-month randomized double-blind controlled clinical trial comparing olanzapine versus lithium in the maintenance treatment of bipolar disorder (Tohen et al. 2005). A study Kok et al. 2007 comparing the effect of lithium augmentation with phenelzine among patients with treatment-resistant major depressive disorder reported two deaths in the lithium group (n = 15) while using nortriptyline . In the phenelzine group (n = 14), one patient died taking phenelzine who took lithium a few months after finishing the trial and two other patients died while continuing use of phenelzine. "
[Show abstract][Hide abstract] ABSTRACT: The management and treatment of patients with suicidal behavior is one of the most challenging tasks for health-care professionals. Patients with affective disorders are at high risk for suicidal behavior, therefore, should be a target for prevention. Numerous international studies of lithium use have documented anti-suicidal effects since the 1970s. Despite the unambiguous evidence of lithium's anti-suicidal effects and recommendations in national and international guidelines for its use in acute and maintenance therapy of affective disorders, the use of lithium is still underrepresented. The following article provides a comprehensive review of studies investigating the anti-suicidal effect of lithium in patients with affective disorders.
[Show abstract][Hide abstract] ABSTRACT: Recent evidence concerning the efficacy of pharmacological and psychological treatments for depression in older individuals will be reviewed. The evidence base addressing the effectiveness of antidepressants in older individuals has significantly increased over the past few years. In particular, some recent acute trials have failed to show superiority of an active drug over placebo, although there is more consistent evidence for the efficacy of continuation and maintenance antidepressant treatment. As for psychological treatments, problem-solving therapy (PST) appears to be effective in mild depression and in patients with mild executive dysfunction; however, interpersonal psychotherapy (IPT) may be less effective. The evidence base for interventions in refractory depression is surprisingly limited. Several recent studies have adopted a pragmatic approach and have evaluated complex 'case management' approaches, most of which have been positive. Future studies are likely to target primary prevention. Preliminary evidence supporting this approach is summarized.
[Show abstract][Hide abstract] ABSTRACT: These practice guidelines for the biological treatment of unipolar depressive disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal for developing these guidelines was to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating patients with these conditions. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for depressive disorders, as well as from meta-analyses and reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into four levels of evidence (A-D). This first part of the guidelines covers disease definition, classification, epidemiology and course of unipolar depressive disorders, as well as the management of the acute and continuation-phase treatment. These guidelines are primarily concerned with the biological treatment (including antidepressants, other psychopharmacological and hormonal medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic strategies) of young adults and also, albeit to a lesser extent, children, adolescents and older adults.
The World Journal of Biological Psychiatry 02/2002; 3(1):5-43. DOI:10.3109/15622975.2013.804195 · 4.18 Impact Factor
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