Discontinuation of lithium augmentation in geriatric patients with unipolar depression: a systematic review

Lithium is an augmentation strategy for unipolar depression in geriatric populations. This review outlines the evidence in the literature regarding risk of relapse when lithium is discontinued in geriatric patients.

Articles were selected based on selection criteria for relevance and design quality (original studies, French or English, patients older than 65 years, patients with an episode of major depressive disorder, meeting DSM-III or greater criteria, and patients who had been successfully treated to remission with lithium augmentation of an antidepressant, then withdrawn from lithium augmentation treatment).

Three articles were found. Overall rate of relapse could not be clearly established but a rate of 50% relapse over about 6 months follow-up could be surmised from the study results.

There is a risk of relapse in elderly patients whose lithium augmentation treatment for unipolar depression is discontinued. More studies with a randomized control trial design are required to provide more definitive information on this topic.