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Re: Anti-psychiatry has surpassed Goebbels

Posted by SLS on April 7, 2006, at 7:07:04

In reply to Re: Anti-psychiatry has surpassed Goebbels Caedmon, posted by Squiggles on April 6, 2006, at 20:27:05

> > > Stahl makes an interesting point that "overall,
> > > lithium is effective in only 40 to 50% of patients"; i find that incredible but he may not
> > > be defining his sample very well.
> >
> > That's what I was wondering. 40-50% of *which* patients?
> >
> > In unipolar depression: I understand, from my pdoc, that even though Li is the most studied drug for antidepressant augmentation, it tends to produce only marginal response in most patients. (It and T3. This might just be his clinical experience, I don't know. Such a statement surprised me, but then, I haven't read very deeply into the literature. Remission v. response are different things - most studies only look at response.)
> >
> I'm not surprised that it should have a small
> effect as an adjunct - even in combination
> with other ADs for UNIPOLAR depression. I don't know how
> the combined chemistry in adjunct therapy would be, but if lithium
> has a "narrow therapeutic index" why should it
> change as an adjunct-- does it potentiate other
> ADs? You would have to study the interactions,
> i guess. It's sort of like colour spectrum
> study isn't it?
> Most reports I have read, esp. see IGSLI,
> report lithium efficacy of 75-80% to bring depression and mania
> down in bipolars - the mania and depression
> seem linked somehow in bipolars; maybe in
> unipolars it is "agitated anxiety"
> and depression, requiring a different combination? Just guessing here.

Lithium does many diverse things inside the brain. Its overall effect on serotoninergic neurotransmission is to increase it. This action is a candidate for the mechanism involved in the augmentation of antidepressants in the treatment of unipolar depression.

I don't know what the track record is of using lithium as an adjunct in unipolar depression in terms of numbers whom respond. However, when it does work, the response can be immediate and dramatic. Dosages used can be as low as 300-600mg, and does not have to produce blood levels as high as those that are considered effective when treating bipolar disorder.

- Scott




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