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Published on: January 7, 2019
Low dosage lithium augmentation in venlafaxine resistant depression: an open-label study
B Alevizos1, E Alevizos, A Leonardou
11st Department of Psychiatry, University of Athens, Eginition Hospital, Athens, Greece.
Psychiatrike = Psychiatriki
|July 17, 2012
Summary
Low-dose lithium augmentation effectively treats resistant depression with fewer side effects. This approach may be a preferred first choice, potentially avoiding the need for plasma level monitoring.
Area of Science:
- Psychiatry and Pharmacology
- Neuroscience and Neurotransmission
Background:
- Lithium augmentation is a well-established strategy for treatment-resistant depression.
- Standard lithium dosages (approx. 900 mg/day, 0.5-0.8 mEq/L plasma level) require careful monitoring due to toxicity risks.
- Low lithium levels may enhance serotonin neurotransmission, suggesting potential efficacy of lower doses.
Purpose of the Study:
- To assess the efficacy and tolerability of low-dose lithium augmentation in patients with treatment-resistant depression.
- To compare the effectiveness of low-dose lithium with standard augmentation strategies.
- To evaluate the need for plasma level monitoring with low-dose lithium.
Main Methods:
- Fifty-one outpatients with severe unipolar or bipolar depression, non-responsive to venlafaxine (300-375 mg/day), were included.
- Following a washout period, patients received venlafaxine plus low-dose lithium carbonate (300-450 mg/day) for six weeks.
- Treatment outcome was assessed using the Clinical Global Impression Improvement scale; bipolar vs. unipolar response was analyzed.
Main Results:
- After five weeks, 51% of patients showed significant improvement ('much' or 'very much' improved).
- Bipolar patients responded better than unipolar patients (64.3% vs. 45.5%, p<0.038).
- A rapid response (within 7 days) was observed in 76% of patients; mean lithium plasma level was 0.33±0.09 mEq/L.
Conclusions:
- Low-dose lithium augmentation is effective and well-tolerated for resistant depression, comparable to higher doses.
- This strategy may not necessitate plasma level monitoring, reducing risks of toxicity and side effects.
- Further controlled studies are needed to confirm findings and compare with standard lithium augmentation.
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