2009 issue 1

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Volume 25, issue 1

Original article

Augmentation of antidepressant drugs in treatment-resistant depression with lithium or lamotrigine (preliminary study)

Janusz Rybakowski1, Maryla Tuszewska1, Maria Chłopocka-Woźniak1
1. Uniwersytet Medyczny w Poznaniu, Klinika Psychiatrii Dorosłych
Farmakoterapia w Psychiatrii i Neurologii, 2009, 1, 17–21
Keywords: treatment-resistant depression, augmentation, lithium, lamotrigine, venlafaxine, paroxetine

Abstract

Aim: The addition of lithium to antidepressant drugs is recognized strategy in case of suboptimal therapeutics results. Lamotrigine is a new generation mood stabilizer exerting distinct antidepressant effect and possible augmentation of antidepressant drugs. The aim of this study was an assessment of augmentation by lithium or lamotrigine of two antidepressant drugs: paroxetine and venlafaxine, in treatment-resistant depression.
Methods: The study was performed on 42 patients (11 men, 32 women), aged 20-67 (mean 47) years with treatmentresistant depression in the course of unipolar or bipolar affective illness. All patients had at least two ineffective courses of antidepressant treatment. The drug immediately preceding lithium or lamotrigine addition was either paroxetine, in the dose up to 60 mg/day, or venlafaxine, in the dose up to 300 mg/day, given for 4 weeks. The addition of lithium (concentration 0.6-0.8 mmol/l) or lamotrigine, 200 mg/day, was randomized.
Results: The intensity of depression before lithium or lamotrigine addition was on Hamilton Depression Scale 18-42 (mean 25) points. The addition of lithium or lamotrigine for 4 weeks resulted in a signifi cant reduction of depressive symptoms (on the average by 19 points). No differences in therapeutic effectiveness were observed between patients added lithium or lamotrigine, however, in the whole group, better effi cacy was obtained in venlafaxine than in paroxetine-treated patients. No correlation was found between the effectiveness of potantiation and type of depression (unipolar or bipolar), duration of illness and duration of depressive episode.
Conclusions: The results of this study point to similar augmentation effi cacy of lithium and lamotrigine. Such augmentation is more effective if added to venlafaxine than to paroxetine.

Address for correspondence:
Janusz Rybakowski
Klinika Psychiatrii Dorosłych, Uniwersytet Medyczny w Poznaniu
ul. Szpitalna 27/33, 60-572 Poznań
tel 61-8475087; fax 61-8480392; e-mail: rybakows@wlkp.top.pl