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Lithium Prophylaxis Appears Safe, Effective For Unipolar Major Depressive Disorder

Lithium appears to be a potent and safe prophylactic agent for recurrent major depressive disorder (MDD) in a naturalistic setting, say researchers.

According to the World Health Organization's recent Global Burden of Disease Study, depression is one of the most important public health concerns. Although there is a considerable need for prophylactic treatment in cases of recurrent MDD, evidence suggests that up to 50% of patients do not receive prophylactic therapy.

Lithium has been demonstrated to be an effective agent in the prophylaxis of MDD. However, most studies on the prophylactic use of lithium in MDD have involved short follow-up periods.

To assess the prophylactic effectiveness of lithium in patients with unipolar MDD over an extended period of time, Christopher Baethge, MD, of the McLean Division of Massachusetts General Hospital, Belmont, United States, and colleagues performed a long-term naturalistic study in 55 patients with MDD treated at an outpatient clinic.

Clinical data was collected prospectively during patient visits to the clinic, scheduled every 1 to 12 weeks according to patient clinical status. During the visits, patients received psychiatric clinical interview, assessment of lithium serum levels and other routine laboratory tests, assessment of psychopathological status (Bech-Rafaelsen Melancholia Scale), and treatment according to the standards of antidepressant pharmacotherapy.

Study outcome measures included change in hospital admission rate during prophylaxis compared with the period before prophylaxis, Morbidity-Index (MI) during prophylaxis, and time to first recurrence after lithium treatment initiation.

Analysis revealed that on average, 11.4 years of illness and 2.4 hospital admissions had passed before lithium prophylaxis was initiated. Patients received follow up for an average of 6.7 years during lithium prophylaxis, during which time 47% of patients experienced at least 1 recurrence.

After lithium prophylaxis was initiated, the number of days spent in hospital fell dramatically from an average of 53 days per year to 1.4 days per year (P < .001; 95% confidence interval 31-73 d). Moreover, the number of psychiatric admissions decreased remarkably.

Only in 6 patients required a change of medication due to side effects or a lack of efficacy. Co-medication was necessary in 21 patients, but the overall outcome of their prophylactic treatment did not differ from the group without co-medication.

Noting that it is unclear which patients should receive antidepressants and which should receive lithium, the researchers conclude that lithium administration might be considered in cases in which the risk of suicide is particularly high or if patients have a family history of bipolar disorder and subsequently at higher risk for manic episodes.

J Psychiatry Neurosci 2003;28:5:355-61. "Effectiveness and outcome predictors of long-term lithium prophylaxis in unipolar major depressive disorder"

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