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Notes:
- The use of lithium
to enhance antidepressant response is both the most widely used and
best studied augmentation strategy.
- Lithium enhances
5-HT transmission by actions on turnover and release. de Montigny, 1994:31(5,6)
- Chronic TCA
usage may induce postsynaptic sensitization to 5-HT, and lithium
addition may alter 5-HT transmission and aid clinical response.
de Montigny, 1994:31(5,6)
- Lithium may
also have effects on other neurotransmitter systems and neuromodulators.
de Montigny, 1994:31(5,6)
- Results from controlled
trials have produced conflicting results on lithium efficacy.
- Three trials
clearly demonstrated the efficacy of lithium over placebo, and three
trials found that the efficacy of lithium could not be distinguished
from placebo.
- Because of
methodologic problems inherent in these studies (eg, small sample
size, duration of response assessment, dosages used), the data is
limited, and the rationale for lithium augmentation is based broadly
on clinical experience and less on empirical research data. Joffe,
1996:26-27
- Results from open
studies and series of cases, case reports, and placebo-controlled studies
support the clinical experience that lithium augmentation of a variety
of antidepressants produces response rates from 30% to 65%. Phillips,
1994:22(10)
- In some cases,
responses were noted within 48 hours, but delays of 3 to 6 weeks
have also been reported. de Montigny, 1994:32(3,4)
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