Posted by doxogenic boy on September 25, 2009, at 9:52:27
In reply to Re: Is Nardil REALLY that effective for panic attacks? » doxogenic boy, posted by SLS on September 24, 2009, at 15:21:35
> From what I have read and in my personal experience, one can expect results within two weeks provided the dosage is high enough. For depression, I don't think you can rule out lithium until you have tried 600mg. The Harvard study used a range of 300-600mg to augment Prozac.
-------Thanks for your advice.
I have some lithium side effects (tremor, somewhat lax bowels, polyuria and frequent urinating) at the current dose, so I think it can be hard to go through a dose twice as high. It seemed like I got more anxiety the first two weeks.> > I don't tolerate high doses of lithium, in the past that made me apathetic and indifferent.
>
> My experience mirrors yours. I start feeling crappy at blood levels as low as 0.45 mmol/L. At 600mg, my level is currently 0.3 mmol/L. I feel that it is important for me to remark that I experienced some of these effects at 300-600mg for a few weeks before they disappeared completely.
-------The side effects disappeared, or the pharmacologic effect disappeared?
From my knowlegde, augmentation for treatment resistant depression, lithium hasn't a very impressing response rate. (When it is about treatment resistant depression, there are few (if any) options with a favourable outcome for most of the patients). In one study, T3 had just as good or better outcome than lithium; fewer discontinued T3.
http://www.ncbi.nlm.nih.gov/pubmed/19594193
CNS Drugs. 2009;23(8):627-47. doi: 10.2165/00023210-200923080-00001.Links
STAR*D: revising conventional wisdom.
Rush AJ, Warden D, Wisniewski SR, Fava M, Trivedi MH, Gaynes BN, Nierenberg AA.Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA. john.rush@duke-nus.sg
The STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study used a series of sequenced, randomized treatment trials following a first and, if needed, subsequent treatment steps to define the tolerability and effectiveness of various options in both acute and longer term treatment. Adult outpatients (n=4041) with nonpsychotic major depressive disorder, substantial chronic and recurrent depression, and co-morbid psychiatric and general medical conditions were enrolled in 41 representative primary and specialty care settings. About one-third of participants remitted in first step treatment with citalopram, 50% of these within 6 weeks.
Poorer outcomes were associated with minority status, socioeconomic disadvantage, more axis I and III co-morbid disorders, lower function and quality of life, and anxious and melancholic features.In step 2 medication switch, there were no significant differences in remission among within-class, out-of-class or dual-action agents: sertraline (27%), bupropion-sustained release (26%) and venlafaxine-extended release (25%). In step 2 medication augmentation of citalopram, there was no significant difference in remission between bupropion-sustained release (39%) and buspirone (33%), although participants using bupropion-sustained release had greater symptom reduction and better tolerability. There were no significant differences in remission in step 2 between cognitive therapy and medication treatment in either the switch (31% vs 27%) or augmentation (31% vs 33%) strategies, although participants in cognitive therapy augmentation had a longer time to remission than those in medication augmentation (55 vs 40 days).
In step 3, there were no differences in remission between a switch to mirtazapine (8%) or nortriptyline (12%), or between augmentation with lithium (13%) or T(3) (triiodothyronine, liothyronine) [25%], although more participants discontinued lithium due to adverse effects than discontinued T(3).
In the fourth step, there was no difference in remission between tranylcypromine (14%) or venlafaxine-extended release plus mirtazapine (16%), although the combination treatment had fewer adverse effects and had the advantages of not requiring a washout period or diet restrictions.
Participants requiring more than two well delivered treatments may be characterized as treatment resistant given the substantially lower remission rates after that point. Treatment resistance was associated with more concurrent axis I or III co-morbid conditions, socioeconomic disadvantage, chronicity and melancholic or anxious features. However, if participants remained in treatment for up to four steps, about 67% reached remission. Times to remission were not substantially longer for later treatment steps. The importance of reaching remission is highlighted by the lower relapse rates in naturalistic follow-up for participants entering in remission compared with those entering with response but not remission (step 1: 34% vs 59%; step 2: 47% vs 68%; step 3: 42% vs 76%; step 4: 50% vs 83%).
Clinical decision making based on the itemized measurement of symptoms and adverse effects at each treatment visit was feasible in STAR*D's real world settings and resulted in adequate dosages and durations of treatment that generally exceeded those typically found in practice settings. Although switch and augmentation strategies could not be directly compared due to the equipoise stratified randomized design, the higher remission rates at step 2 with medication augmentation are intriguing and merit further study.
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http://www.ncbi.nlm.nih.gov/pubmed/19684420Neuropsychobiology. 2009;60(1):23-30. Epub 2009 Aug 14.Click here to read Links
Long-term outcome after lithium augmentation in unipolar depression: focus on HPA system activity.
Adli M, Bschor T, Bauer M, Lucka C, Lewitzka U, Ising M, Uhr M, Mueller-Oerlinghausen B, Baethge C.Department of Psychiatry and Psychotherapy, Charité - Universitatsmedizin Berlin, Campus Charité Mitte, Berlin, Germany. mazda.adli@charite.de
BACKGROUND: Lithium augmentation is a first-line strategy for depressed patients resistant to antidepressive therapy, but little is known about patients' subsequent long-term course or outcome predictors. We investigated long-term outcomes of unipolar depressed patients who had participated in a study on the effects of lithium augmentation on the hypothalamic-pituitary-adrenocortical system using the combined dexamethasone/corticotrophin-releasing hormone (DEX/CRH) test. METHODS: Twelve to 28 months (mean 18.6 +/- 4.6 months) after lithium augmentation, 23 patients were assessed with a standardized interview, of which 18 patients had complete DEX/CRH test results. Relapse was diagnosed by DSM-IV criteria (Structured Clinical Interview for DSM-IV; SCID I). RESULTS: Only 11 patients (48%) had a favorable follow-up, defined as absence of major depressive episodes during the observation period. Patients with a favorable and an unfavorable course did not differ in clinical or sociodemographic parameters, endocrinological results or continuation of lithium. However, fewer previous depressive episodes tended to correlate (p = 0.09) with a favorable course. CONCLUSION: Results from studies using the DEX/CRH test to predict relapse in depressed patients treated with antidepressants were not replicated for lithium augmentation. Our finding could reflect the elevation of DEX/CRH results by lithium, independent of clinical course. Limitations of the study are its small sample size, the heterogeneous clinical baseline conditions and the lack of lithium serum levels. The fact that lithium continuation did not predict the course might be related to the difference between the efficacy of lithium in controlled studies and its effectiveness in naturalistic settings. Copyright 2009 S. Karger AG, Basel.
------------doxogenic
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