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Outcome in refractory depression.

S S Shergill1, M M Robertson, G Stein

  • 1Institute of Psychiatry, London, UK.

Journal of Affective Disorders
|September 1, 1999
PubMed
Summary
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Lithium augmentation offers good long-term outcomes for refractory depression in 72% of patients. Prognostic indicators for treatment success are similar to general depression outcomes.

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Up to 40% of patients with depressive illness do not respond to first-line antidepressant treatment.
  • Lithium augmentation is an established strategy for managing treatment-resistant depression.
  • Long-term outcomes and optimal management strategies for lithium augmentation require further clarification.

Purpose of the Study:

  • To describe the long-term (4-8 year) naturalistic follow-up of patients treated with lithium augmentation.
  • To assess the long-term outcomes of lithium augmentation in refractory depression.

Main Methods:

  • Follow-up involved personal interviews, telephone contact, and general practitioner consultations.
  • Lifetime clinical status was assessed using the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L).

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Main Results:

  • Outcome data were obtained for 53 out of 76 eligible patients.
  • A good outcome was observed in 38 patients (72%).
  • Good outcomes were associated with less endogenous depression and no prior hospitalizations.

Conclusions:

  • No specific prognostic indicators for long-term lithium augmentation outcomes were identified beyond general depression prognostic factors.
  • Conclusions are limited by incomplete follow-up and lack of objective data on illness and medication during the follow-up period.