Lithium in Tricyclic-Resistant Depression Correlation of Increased Brain 5-HT Function with Clinical Outcome

1991 ◽  
Vol 159 (3) ◽  
pp. 341-346 ◽  
Author(s):  
P. J. Cowen ◽  
S. L. McCance ◽  
C. J. Ware ◽  
P. R. Cohen ◽  
J. S. Chalmers ◽  
...  
Keyword(s):  
Lithium Treatment ◽  
Antidepressant Medication ◽  
Tricyclic Antidepressant ◽  
Antidepressant Effect ◽  
Endocrine Response ◽  
Treatment Combination ◽  
Prolactin Release ◽  
Limited Support ◽  
Resistant Depression ◽  
Prolactin Response

The addition of lithium to the tricyclic antidepressant medication of 23 patients with major depression resulted in an increase in the prolactin response to intravenous l-tryptophan after both four days and four weeks of treatment. The extent of this increase did not distinguish the ten patients who were classified as clinical responders (> 50% reduction in score on the HRSD). Among the responders there was a modestly significant correlation between the decrease in score on the HRSD and the enhancement of tryptophan-induced prolactin release. Some responders, however, showed very little change in this endocrine response over the four weeks of lithium treatment. Lithium may increase brain 5-HT function in tricyclic-resistant depression but there is only limited support for the hypothesis that changes in brain 5-HT function are involved in the antidepressant effect of this treatment combination.

Lithium Augmentation in Antidepressant-Resistant Patients a Quantitative Analysis

1991 ◽  
Vol 159 (4) ◽  
pp. 510-514 ◽  
Author(s):  
M.-P. V. Austin ◽  
F. G. M. Souza ◽  
G. M. Goodwin
Keyword(s):  
Quantitative Analysis ◽  
Odds Ratio ◽  
Lithium Treatment ◽  
Effect Sizes ◽  
Antidepressant Effect ◽  
Treatment Resistant ◽  
Duration Of Treatment ◽  
Considerable Uncertainty ◽  
Resistant Depression ◽  
Lithium Augmentation

A quantitative analysis was used to examine the efficacy of lithium augmentation in the acute treatment of depressed patients resistant to a standard trial of an antidepressant. Effect sizes were measured by the odds ratio using the Mantel–Haenszel method. Only controlled trials were included in order to minimise bias in method. A highly statistically significant effect for lithium augmentation was found, the pooled odds ratio being 0.146 and its 95% confidence interval 0.05–0.44 (i.e. the odds of remaining ill are reduced by between 56% and 95% with the use of lithium treatment). While these results support the case for lithium augmentation in treatment-resistant depression, there remains considerable uncertainty over the duration of treatment necessary to see and sustain the treatment response.

Lithium Augmentation Therapy in Tricyclic-Resistant Depression

1993 ◽  
Vol 162 (5) ◽  
pp. 634-640 ◽  
Author(s):  
George Stein ◽  
Morris Bernadt
Keyword(s):  
Low Dose ◽  
Controlled Trial ◽  
Depressive Illness ◽  
Tricyclic Antidepressant ◽  
Antidepressant Effect ◽  
Significant Difference ◽  
Resistant Depression ◽  
Drug Responsiveness ◽  
Experimental Group ◽  
Lithium Augmentation

Thirty-four patients with tricyclic-resistant depressive illness took part in a nine-week, doubleblind, placebo-controlled trial of lithium augmentation. In addition to the maximum tolerated doses of their tricyclic antidepressant, the experimental group (n= 16) received 250 mg lithium daily for three weeks, followed by 750 mg lithium daily for six weeks, while the controls (n= 18) received placebo for three weeks followed by three weeks each of 250 mg lithium daily and 750 mg lithium daily. There was no significant difference between placebo and 250 mg lithium for weeks 0-3 of the trial. However, there was a significantly greater improvement on the MADRS for weeks 3-6 for those subjects on 750 mg lithium than for those on 250 mg lithium. In addition, using a 50% fall in the HRSD as a criterion of drug responsiveness, 22% responded to placebo, 18% to 250 mg lithium, and 44% to 750mg lithium. Thus, lithium in normal, but not in low, dose has a significant antidepressant effect in TCA-resistant depression. Further controlled studies using lithium in normal dose in trials which have a greater duration of placebo exposure are required to confirm the lithium augmentation effect.

scholarly journals Management of Chronic Tension-Type Headache With Tricyclic Antidepressant Medication, Stress Management Therapy, and Their Combination

JAMA ◽  
2001 ◽  
Vol 285 (17) ◽  
pp. 2208 ◽  
Author(s):  
Kenneth A. Holroyd ◽  
Francis J. O'Donnell ◽  
Michael Stensland ◽  
Gay L. Lipchik ◽  
Gary E. Cordingley ◽  
...  
Keyword(s):  
Stress Management ◽  
Antidepressant Medication ◽  
Tension Type Headache ◽  
Tricyclic Antidepressant ◽  
Chronic Tension Type Headache ◽  
Type Headache

scholarly journals Ketamine—New Possibilities in the Treatment of Depression: A Narrative Review

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1186
Author(s):  
Mateusz Kowalczyk ◽  
Edward Kowalczyk ◽  
Paweł Kwiatkowski ◽  
Łukasz Łopusiewicz ◽  
Monika Sienkiewicz ◽  
...  
Keyword(s):  
Antidepressant Effect ◽  
Depression Symptoms ◽  
Drug Resistant ◽  
Depression And Anxiety ◽  
Psychoactive Substances ◽  
Worldwide Population ◽  
Treatment Of Depression ◽  
Resistant Depression ◽  
Depressive Episodes ◽  
Rapid Treatment

The SARS-CoV-2 coronavirus epidemic has led to an increase in the number of people with depression. Symptoms related to the mental sphere (mainly depression and anxiety) may be experienced by one third of the worldwide population. This entails the need for the effective and rapid treatment of depressive episodes. An effective drug seems to be s-ketamine, which was accepted in March 2019 by the Food and Drug Administration (FDA) for the treatment of drug-resistant depression. This drug provides a quick antidepressant effect with maximum effectiveness achieved after 24 h. It also appears to reduce the occurrence of suicidal thoughts. However, research into undesirable effects, especially in groups of people susceptible to psychotic episodes or those who use alcohol or psychoactive substances, is necessary.

Combining Pharmacotherapy and Psychological Treatments for OCD

2012 ◽  
Author(s):  
David F. Tolin ◽  
Blaise L. Worden
Keyword(s):  
Serotonin Reuptake ◽  
Behavioral Therapy ◽  
Combined Therapy ◽  
Antidepressant Medication ◽  
Exposure And Response Prevention ◽  
Treatment Combination ◽  
Obsessive Compulsive ◽  
Quantitative Review ◽  
Psychological Treatments ◽  
Compulsive Disorder

This chapter reviews the outcome literature on the efficacy of combined pharmacotherapy and cognitive-behavioral therapy (CBT) for obsessive compulsive disorder (OCD). By far, most research on combinations of CBT and pharmacotherapy for OCD has examined antidepressant medications, particularly those in the serotonin reuptake inhibitor (SRI) class. Quantitative review of randomized studies in which treatments were combined simultaneously indicated that combined therapy shows a small but significant advantage over exposure and response prevention (ERP) monotherapy, and a moderate advantage over pharmacologic (antidepressant) monotherapy. Studies of sequential treatment combination, in which CBT was added after a trial of antidepressant medication, suggest a significant incremental benefit of CBT, including for patients who show minimal response to antidepressant medication alone. The chapter concludes by discussing new pharmacologic possibilities for combined therapy, such as the use of D-cycloserine (DCS).

scholarly journals Pharmacological Treatments for Patients with Treatment-Resistant Depression

2020 ◽  
Vol 13 (6) ◽  
pp. 116 ◽  
Author(s):  
Valerie L. Ruberto ◽  
Manish K. Jha ◽  
James W. Murrough
Keyword(s):  
Treatment Options ◽  
Symptom Relief ◽  
Antidepressant Medication ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Qualitative Synthesis ◽  
Course Of Illness ◽  
Effective Strategies ◽  
Increased Risk ◽  
Resistant Depression

Over a third of patients with major depressive disorder (MDD) do not have an adequate response to first-line antidepressant treatments, i.e., they have treatment-resistant depression (TRD). These patients tend to have a more severe course of illness and are at an increased risk of suicide. Next step treatment options for patients with TRD, include switching to a different antidepressant, combining more than one antidepressant, or augmenting an antidepressant with another (non-antidepressant) medication. It is unclear which of these treatment approaches should be applied to a given patient, and in what order. Due to this ambiguity, comparing antidepressants and augmentation agents on the basis of their efficacy, tolerability, and speed of symptom relief would be beneficial for clinicians. To accomplish this, a systematic search was conducted following PRISMA guidelines. Only randomized controlled trials were included in this qualitative synthesis, resulting in 66 articles. This review identified several effective pharmaco-therapeutic strategies that are currently available for patients with TRD. Ketamine and esketamine appear to be effective for the treatment of TRD. Augmentation with certain second generation antipsychotics, such as quetiapine or aripiprazole is likewise effective, and may be preferred over switching to antidepressant monotherapy. While the combination of olanzapine and fluoxetine was one of the first pharmacotherapy approved for TRD, and its use may be limited by metabolic side-effects. Other effective strategies include augmentation with lithium, liothyronine (T3), lamotrigine, or combination of antidepressants including bupropion, tricyclics, or mirtazapine. There is insufficient research to demonstrate the efficacy of ziprasidone or levothyroxine (T4). A shared decision-making approach is recommended to guide treatment selection to address each patient’s individual needs.

An evaluation of continuation therapy with tricyclic antidepressants in depressive illness

1973 ◽  
Vol 3 (1) ◽  
pp. 5-17 ◽  
Author(s):  
R. H. S. Mindham ◽  
C. Howland ◽  
Michael Shepherd
Keyword(s):  
Antidepressant Medication ◽  
Complete Recovery ◽  
Depressive Illness ◽  
Tricyclic Antidepressant ◽  
Trial Period ◽  
Double Blind ◽  
Residual Symptoms ◽  
Continuation Therapy ◽  
Double Blind Clinical Trial ◽  
Lower Dose Level

SynopsisA double-blind clinical trial has been carried out to ascertain whether patients making a good recovery from depressive illness with tricyclic antidepressant medication derive any benefit from continuation of therapy with the same drug at a lower dose level. Of the 92 patients who entered the trial significantly fewer on active treatment relapsed during the six-month trial period: 22% as compared with 50% of patients receiving placebo. Patients with residual symptoms on entry to the trial derived more benefit from continuation therapy than patients who had made a complete recovery. The findings relate to a six-month trial period only, and any possible advantage of continuation therapy over a longer period remains uncertain.

Effects of Methylphenidate in HIV-Related Depression: A Comparative Trial with Desipramine

1995 ◽  
Vol 25 (1) ◽  
pp. 53-67 ◽  
Author(s):  
Francisco Fernandez ◽  
Joel K. Levy ◽  
H. Russell Samley ◽  
Francis J. Pirozzolo ◽  
David Lachar ◽  
...  
Keyword(s):  
Depressive Symptomatology ◽  
Comparative Trial ◽  
Tricyclic Antidepressant ◽  
Dose Titration ◽  
Antidepressant Effect ◽  
Individual Dose ◽  
Double Blind ◽  
Antidepressant Effects ◽  
Daily Dose ◽  
The Mean

This report is a randomized, double-blind, comparative trial of desipramine with the psychomotor stimulant methylphenidate. Twenty HIV antibody-positive patients with depressive symptoms were randomly assigned to either drug. After individual dose titration, the mean daily dose of desipramine was 150 mg. and methylphenidate 30 mg. daily. The differences in responses between desipramine and methylphenidate were not statistically significant on various measures of depression. The antidepressant effect of methylphenidate did not occur any faster than that of desipramine. Both significantly reduced depressive and anxious symptomatology over the blinded portion of the treatments. Thus, methylphenidate relieves depressive symptomatology with efficacy similar to that of desipramine, offering an alternative to patients who are unable to tolerate standard tricyclic antidepressant therapy. The dopaminergic effects of methylphenidate are likely to mediate its antidepressant effects.

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