LITHIUM IN TREATMENT OF RESISTANT DEPRESSION
Claude
De Montigny, MD, PhD, FRCPC
Department of Psychiatry, Neurobiological Psychiatry Unit, McGill University
1992
About
one-third of depressed patients do not respond satisfactorily to antidepressant drugs. Until recently, electroconvulsive therapy
was considered as the treatment of choice for these patients.
We have shown that the short-term administration of low doses of lithium enhances
the function of serotonin-containing neurons.
We published our first observations in eight patients in 1981. All eight patients,
who had failed to improve with a treatment of at least three weeks with an antidepressant drug, showed a clinically significant
improvement 48 hours after the addition of lithium to their therapeutic regimens.
This report was received enthusiastically by the international scientific community,
although, as is the case for any new finding, some expressed skepticism.
However, since then, over 50 reports in scientific journals have not only confirmed
the efficacy of this therapeutic strategy in resistant depression, but have shown it to be useful in depressions resistant
to a wide range of antidepressant treatments. It is currently estimated that about 70% of treatment-resistant depressions
respond favourably to lithium addition.
Lithium augmentation is now used worldwide as a first choice strategy in treatment-resistant
depression.
LITHIUM DRUGS FOUND TO REDUCE SUICIDE RISK
Harvard Gazette, December 13, 2001
Lithium drugs may reduce the risk of suicide among people with severe recurrent
depression by as much as 82 percent, according to a new Harvard study. That finding may help millions of people who struggle
with potentially lethal mood disorders.
The researchers, working at Harvard-affiliated McLean Hospital in Belmont, analyzed
22 studies involving 5,647 patients. Those who took the drug showed a nine-fold lower rate of suicide compared to those who
did not.
"The evidence we have provides strong, consistent support that suicides are dramatically
lower with than without long-term lithium treatment," says Ross Baldessarini, a professor of psychiatry who participated in
the study. He estimates that 10 million people in the United States with major mood disorders could be affected by these results.
At present, the drugs most commonly prescribed for depression are so-called selective
serotonin reuptake inhibitors, such as Celexa, Paxil, Prozac, and Zoloft. These medications are safer than lithium-containing
drugs, which include Lithobid, Eskalith, and several generic products. However, in another study Baldessarini and his colleagues
found no evidence that serotonin drugs and other antidepressants reduce risk of suicide.
Striking results
Baldessarini and colleagues Leonardo Tondo and John Hennen reported their results
in recent issues of the international medical journal Acta Pyschiatrica Scandinavica and in the Annals of the New York Academy
of Sciences. They write that "despite the grave personal, social, and economic impact of suicide and its strong association
with depressive disorders, specific studies on the effects of mood-altering treatments on suicide risk remain uncommon."
Suicide risk in people with mood disorders is 10 to 20 times higher than that in
the general population, and as many as 25 percent of severely depressed or manic-depressive patients take their own lives.
In a search for ways to reduce this toll, the Harvard researchers analyzed 22 studies conducted between 1970 and 1998. They
compared suicide rates among patients who took lithium for several months to more than a year with those who did not take
the drug.
"The results were clear and striking, particularly among bipolar manic-depressive
patients," Baldessarini comments. They reinforced the Harvard group's other finding that suicides and suicide attempts increased
20 times in manic-depressives within the first year after abruptly discontinuing lithium treatment. After the first year off
lithium, rates of suicidal behavior were virtually identical to those before patients started the treatment.
An 82 percent, or nine-fold reduction, in suicide risk is impressive. Even a much
lesser reduction in the likelihood of death from, say, a cancer drug would be phenomenal.
Yet despite the popularity of newer drugs, Baldessarini maintains that, "our analysis
shows that lithium is a good option to choose for long-term treatment of severe depression, particularly depression associated
with bipolar manic-depression."
