Lithium augmentation in the treatment of delusional depression

Five patients suffering with delusional depression, and who were resistant to tricyclic antidepressants, were successfully treated with lithium carbonate. Delusional depression does not usually respond to tricyclic antidepressants, and ECT has been considered the treatment of choice. Such patients often refuse to acknowledge that they are ill. They, therefore, understandably often refuse to accept ECT. In order to treat, the Mental Health Act 1983 must be invoked. Treatment with lithium carbonate is more acceptable to most patients, and in the cases described, patients agreed to take this drug whereas they had refused to accept ECT.