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Lithium and Venlafaxine Both Helpful Adjuncts in Depressed Patients Unresponsive to Selective Serotonin Reuptake Inhibitors: Presented at CPA

By Louise Gagnon

MONTREAL, QC -- October 19, 2004 -- Patients with depression who fail to successfully respond to selective serotonin reuptake inhibitor (SSRI) monotherapy can be administered lithium or venlafaxine in addition to an SSRI, according to a pilot study at the 54^th Canadian Psychiatric Association Annual Meeting.

"No more than a third of patients who receive medication for depression achieve the goals of therapy -- achieving and sustaining a remission," explained researcher Roger McIntyre, MD, Assistant Professor of Psychiatry, University of Toronto, and Head, Mood Disorders Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. "That would mean the majority of patients require a further pharmacological or psychosocial intervention to enhance the overall remission rates."

In a single-blind, randomized controlled study, 33 adults under the age of 66 received either extended-release venlafaxine 75 to 375mg/day or lithium 300 to 900 mg/day, and titrated every 2 weeks until clinical response was achieved.

Researchers found statistically significant changes in the subjects' scores on the Hamilton Depression Rating Scale (HDRS), from baseline (non-response rating of 16+ or partial response rating of 8-15) to end point. There was no difference between the lithium and venlafaxine groups in terms of response.

Furthermore, the shift in Clinical Global Impression-Improvement Score was also statistically significant. The data suggest that venlafaxine added to an SSRI could increase the overall effect from what was an insufficient SSRI trial, added Dr. McIntyre.

Of the 18 male patients, 9 received venlafaxine and 9 received lithium. Of the 15 females, 7 received Venlafaxine and 8 received lithium. [PLEASE CONFIRM.]Patients recruited to the study had been on antidepressants, including citalopram, fluvoxamine, paroxetine, fluoxetine, and sertraline.

"We found that lithium and venlafaxine were very similar in their overall efficacy as an adjunct strategy to the SSRI," said Dr. McIntyre. "There were no differences between the 2 groups in terms of side effects either."

Adverse events were reported in 87.5% of patients who received venlafaxine XR and in 88% of patients who received lithium

"We need to do a randomized controlled trial where we would take patients who have failed on an SSRI, adding possible other agents to see what the effect would be," concluded Dr. McIntyre.

This study was sponsored by Wyeth Pharmaceuticals Inc.


[Presentation title: "A Single-blind, Randomized Lithium-controlled Efficacy and Safety Trial of Venlafaxine (Effexor XR) in Subjects Experiencing a Major Depressive Episode (According to DSM-IV Criteria) Who Are Partial or Non-responders to SSRI Anti-depressants." Abstract 55]

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