Posted by SalArmy4me on August 28, 2001, at 21:23:31
In reply to Has anyone experienced Effexor poop-out?, posted by SLS on August 28, 2001, at 8:18:25
Hoencamp, Erik MD PhD. Lithium Augmentation of Venlafaxine: An Open-Label Trial. Journal of Clinical Psychopharmacology. 20(5), Oct 2000.
"Lithium augmentation of venlafaxine therapy has not previously been reported. In this study, treating patients with depression with venlafaxine alone produced a significant response at week 7, and augmentation with lithium for 6 weeks provided a further improvement in response. The addition of lithium to venlafaxine treatment was well tolerated, and most adverse events were mild-to-moderate in severity. Only one patient discontinued for adverse events during augmentation. The tolerability profile with venlafaxine alone was consistent with that previously reported.16
Overall, this patient population could be characterized as more severely depressed before treatment as evidenced by the duration of depression, the number of previous antidepressant treatments, and the mean rating scale scores at baseline. In addition, those patients requiring augmentation tended to have more severe depression on the basis of a longer duration and higher scores on depression rating scales.
Results from previous studies have indicated the benefits of lithium augmentation of selective serotonin reuptake inhibitors and tricyclic antidepressants.17, 18 Lithium augmentation seems to be most effective when added sequentially to an adequate trial of an antidepressant in nonresponding patients, as was done here.19 Factors that may be predictive of a response to lithium augmentation include the presence of bipolar depression, less severe depression, and rapid improvement to lithium addition.20 The initiation of treatment with lithium and an antidepressant concurrently was not found to be effective in two placebo-controlled trials of patients with non-treatment-resistant depression.9, 10 Previous studies have indicated that a lithium plasma level of at least 0.7 mEq/L is required for maximal effectiveness during augmentation.21
Preclinical studies have shown that venlafaxine and ODV, its major metabolite, are both potent inhibitors of serotonin and noradrenaline reuptake.22 A study in healthy volunteers found that after doses of 75 to 450 mg/day, venlafaxine and ODV demonstrated linear pharmacokinetics, with mean peak plasma concentrations of venlafaxine ranging from 53 to 393 ng/mL and a mean peak plasma concentration of ODV ranging from 148 to 686 ng/mL.23 The combined plasma concentration area under the curve for venlafaxine and ODV was linear.23 In this study, plasma venlafaxine and ODV levels were significantly correlated with improvement in HAM-D and MADRS scores as represented by the change from baseline. Although a positive dose-response effect has been demonstrated with venlafaxine in clinical trials,16 these are the first reported data to suggest a plasma concentration-response relationship with venlafaxine and ODV. This cannot be attributed to a drug interaction, because administration of venlafaxine in combination with lithium to healthy volunteers had no effect on the pharmacokinetic profile of venlafaxine or ODV, nor did it alter the pharmacokinetics of lithium.24 However, more research is needed to elucidate the relationship between response and plasma levels."
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poster:SalArmy4me
thread:76695
URL: http://www.dr-bob.org/babble/20010828/msgs/76768.html