Predicting outcome of lithium added to antidepressants in resistant depression

• Published in: Journal of affective disorders Vol. 42; no. 2; pp. 179 - 186
• Main Authors: Álvarez, E, Pérez-Solá, V, Pérez-Blanco, J, Queraltó, J.M, Torrubia, R, Noguera, R
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.02.1997; Elsevier
• Subjects: Adolescent; Adult; Aged; Antidepressants; Antidepressive Agents, Tricyclic - administration & dosage; Antidepressive Agents, Tricyclic - adverse effects; Biological and medical sciences; Depression; Depressive Disorder - diagnosis; Depressive Disorder - drug therapy; Depressive Disorder - psychology; Dexamethasone; Drug Therapy, Combination; Female; Humans; Hydrocortisone - blood; Imipramine - administration & dosage; Imipramine - adverse effects; Lithium; Lithium Carbonate - administration & dosage; Lithium Carbonate - adverse effects; Male; Medical sciences; Middle Aged; Neuropharmacology; Outcome; Personality Inventory; Pharmacology. Drug treatments; Predictive Value of Tests; Predictor; Prognosis; Prospective Studies; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Resistant depression; Treatment Outcome; Lithium; Depression; Resistant depression; Antidepressants; Predictor; Outcome; Human; Mood disorder; Drug combination; Steroid hormone; Psychotropic; Treatment efficiency; Prediction; Tricyclic compound; Hydrocortisone; Glucocorticoid; Dexamethasone test; Chemotherapy; Treatment; Adrenal hormone; Antidepressant agent; Hormonal investigation; Negative therapeutic reaction
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/S0165-0327(96)01407-3

This study was conducted to assess the predictive value of different variables including the response to dexamethasone suppression test (DST), in 105 patients with resistant depression after the addition of lithium (600 to 800 mg/day) for 4 weeks to antidepressant medication. Clinical remission was observed in 57 patients and no improvement in 48. A dramatic and rapid relief of depression occurred in 12 patients. Variables with significant or marginally significant differences between responders and non-responders were included in a stepwise logistic regression model. Weight loss ( P=0.0013) and depressive psychomotor activity ( P=0.045) in the Newcastle diagnostic index (NDI) scale, and overall score of the Hamilton Rating Scale for Depression (HRSD) before adding the lithium ( P=0.0039) were significantly associated with clinical remission. The difference in post-DST cortisol plasma levels between both groups was marginally significant. The logistic equation resulted in a sensitivity of 78% and a specificity of 65% and total correct classification of the lithium-added response of 72%. The clinical profile of patients who improve with the addition of lithium may include significant weight loss, psychomotor retardation and possibly, poor control of cortisol secretion. Partial remission before adding lithium as well as endogenomorphic traits according to NDI may also be considered additional criteria for response.