Juan Undurraga1,2, Kang Sim1,3, Leonardo Tondo1,4,5, Ariel Gorodischer6, Emilio Azua7, Kai Hong Tay3, David Tan3, Ross J Baldessarini1,4. 1. 1 International Consortium for Mood and Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA. 2. 3 Early Intervention Program, J Horwitz Psychiatric Institute, Santiago, Chile. 3. 4 Research Division, Institute of Mental Health/Woodbridge Hospital, Singapore. 4. 5 Department of Psychiatry, Harvard Medical School, Boston, MA, USA. 5. 6 Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy. 6. 7 Department of Psychiatry, Universidad de Los Andes, Santiago, Chile. 7. 8 Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile.
Abstract
BACKGROUND: The potential value of lithium treatment in particular aspects of unipolar major depressive disorder remains uncertain. METHODS: With reports of controlled trials identified by systematic searching of Medline, Cochrane Library, and PsycINFO literature databases, we summarized responses with lithium and controls followed by selective random-effects meta-analyses. RESULTS: We identified 36 reports with 39 randomized controlled trials: six for monotherapy and 12 for adding lithium to antidepressants for acute major depression, and 21 for long-term treatment. Data for monotherapy of acute depression were few and inconclusive. As an adjunct to antidepressants, lithium was much more effective than placebo ( p<0.0001). For long-term maintenance treatment, lithium was more effective than placebo in monotherapy ( p=0.011) and to supplement antidepressants ( p=0.038), and indistinguishable from antidepressant monotherapy. CONCLUSIONS: The findings indicate efficacy of lithium as a treatment for some aspects of major depressive disorder, especially as an add-on to antidepressants and for long-term prophylaxis. It remains uncertain whether some benefits of lithium treatment occur with many major depressive disorder patients, or if efficacy is particular to a subgroup with bipolar disorder-like characteristics or mixed-features.
BACKGROUND: The potential value of lithium treatment in particular aspects of unipolar major depressive disorder remains uncertain. METHODS: With reports of controlled trials identified by systematic searching of Medline, Cochrane Library, and PsycINFO literature databases, we summarized responses with lithium and controls followed by selective random-effects meta-analyses. RESULTS: We identified 36 reports with 39 randomized controlled trials: six for monotherapy and 12 for adding lithium to antidepressants for acute major depression, and 21 for long-term treatment. Data for monotherapy of acute depression were few and inconclusive. As an adjunct to antidepressants, lithium was much more effective than placebo ( p<0.0001). For long-term maintenance treatment, lithium was more effective than placebo in monotherapy ( p=0.011) and to supplement antidepressants ( p=0.038), and indistinguishable from antidepressant monotherapy. CONCLUSIONS: The findings indicate efficacy of lithium as a treatment for some aspects of major depressive disorder, especially as an add-on to antidepressants and for long-term prophylaxis. It remains uncertain whether some benefits of lithium treatment occur with many major depressive disorderpatients, or if efficacy is particular to a subgroup with bipolar disorder-like characteristics or mixed-features.
Entities:
Keywords:
Lithium; systematic review; unipolar major depression
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