A systematic review and meta-analysis of lithium augmentation of tricyclic and second generation antidepressants in major depression.

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State: Public
Version: author
Serval ID
serval:BIB_CA7C07CA45A2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
A systematic review and meta-analysis of lithium augmentation of tricyclic and second generation antidepressants in major depression.
Journal
Journal of Affective Disorders
Author(s)
Nelson J.C., Baumann Pierre, Delucchi K., Joffe R., Katona C.
ISSN
1573-2517 (Electronic)
ISSN-L
0165-0327
Publication state
Published
Issued date
2014
Peer-reviewed
Oui
Volume
168
Pages
269-275
Language
english
Notes
Publication types: Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Abstract
BACKGROUND: Lithium augmentation of antidepressants for treatment of unipolar major depression was one of the first adjunctive strategies based on a neuropharmacologic rationale. Randomized controlled trials supported its efficacy but most trials added lithium to tricyclic antidepressants (TCAs). Despite its efficacy, use of lithium augmentation remains infrequent. The current systematic review and meta-analysis examines the efficacy of lithium augmentation as an adjunct to second generation antidepressants as well as to TCAs and considers reasons for its infrequent use.
METHOD: A systematic search of Medline and the Cochrane Clinical Trials database was performed. Randomized, placebo-controlled trials of lithium augmentation were selected. A fixed-effects meta-analysis was performed. Odds ratios for response were calculated for each treatment-control contrast, for the trials grouped by type of initial antidepressant (TCA or second generation antidepressant), and as a meta-analytic summary for all treatments combined.
RESULTS: Nine trials that included 237 patients were selected. The odds ratio for response to lithium vs. placebo in all contrasts combined was 2.89 (95% CI 1.65, 5.05, z=3.72, p=0.0002). Heterogeneity was very low, I(2)=0%. Adjunctive lithium was effective with TCAs (7 contrasts) and with second generation agents (3 contrasts). Discontinuation due to adverse events was infrequent and did not differ between lithium and placebo.
LIMITATIONS: The meta-analysis is limited by the small size and number of trials and limited data for treatment resistant patients.
CONCLUSIONS: Adjunctive lithium appears to be as effective for second generation antidepressants as it was for the tricyclics.
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31/08/2015 15:13
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20/08/2019 16:45
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