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Placebo-Controlled Trial of Lithium Augmentation of Fluoxetine and Lofepramine

Published online by Cambridge University Press:  02 January 2018

Cornelius L. E. Katona ,
Mohammed T. Abou-Saleh ,
Deborah A. Harrison ,
Bertrand A. Nairac ,
Denzil R. L. Edwards ,
Toni Lock ,
Robert A. Burns  and
Mary M. Robertson
Cornelius L. E. Katona*
Affiliation:
Department of Psychiatry, University College London Medical School
Mohammed T. Abou-Saleh
Affiliation:
Department of Psychiatry, Royal Liverpool Hospital
Deborah A. Harrison
Affiliation:
Lilly Industries Ltd, Dextra Court, Chapel Hill, Basingstoke, Hampshire RG 21 2SY
Bertrand A. Nairac
Affiliation:
Department of Psychiatry, University College London Medical School
Denzil R. L. Edwards
Affiliation:
Department of Psychiatry, University College London Medical School
Toni Lock
Affiliation:
Department of Psychiatry, Royal Liverpool Hospital
Robert A. Burns
Affiliation:
Department of Psychiatry, Royal Liverpool Hospital
Mary M. Robertson
Affiliation:
Department of Psychiatry, University College London Medical School
*
Professor Cornelius L. E. Katona, Department of Psychiatry, University College London Medical School, Wolfson Building, Middlesex Hospital, London W1N 8AA
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Abstract

Background

This study was designed to establish whether (as suggested in a number of open and relatively small controlled trials) lithium augmentation is more effective than continued antidepressant alone, where response to a standard course of antidepressant treatment has been absent or partial.

Method

Lithium or placebo was added on a double-blind basis for six weeks to the drug regime of 62 patients with major depressive illness (in both hospital and primary care settings) who had failed to respond to a controlled trial of fluoxetine or lofepramine. Response was defined as a final Hamilton Depression Rating Scale (HDRS) score of < 10.

Results

Response was seen more frequently in patients taking lithium (15/29) than in those remaining on antidepressant alone (8/32; P < 0.05). Rapid response to lithium augmentation (LA) was not consistently observed in this cohort. Mean HDRS scores after six weeks were significantly lower (P < 0.01) in the lithium group after excluding those who had not achieved significant exposure to lithium (arbitrarily defined as two or more lithium levels ≥ 0.4 mmol/1). No differences in the efficacy of LA were apparent between fluoxetine and lofepramine.

Conclusions

Our results confirm that LA is a useful strategy in the treatment of antidepressant-resistant depression. Partial response was, however, frequently observed with continued antidepressant treatment alone, and the superiority of LA appears to depend on achieving adequate serum lithium levels.

Type
Papers
Information
The British Journal of Psychiatry , Volume 166 , Issue 1 , January 1995 , pp. 80 - 86
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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