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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Girlnterrupted78 on September 25, 2008, at 19:48:33
I am currently doing group therapy and seeing a new psychiatrist. I'm taking Celexa 20mgs (after a horrible year on Nardil) and the 20mgs is doing very little, and if I raise it to 40mgs, it gives me a horrible stiff neck and jaw.So anyway, I read an article that I found at my clinic where the author, an MD/psychopharmacologist, recommended lithium to augment/potentiate an AD.
I mentioned this to my psychiatrist, and he said that those kinds of reading materials ( offered by the actual clinic!) were not to be taken seriously.
Then I brought this up in group therapy, and even showed them the pamphlet I read, and one of the guys in therapy spoke with a lot confidence and even authority! on the matter, and said absolutely not, lithium is only to treat bipolar disorder, and there's NO WAY I should use it to augment or otherwise.
Then I went online and found this:
"Double-blind, placebo-controlled trial of the use of lithium to augment antidepressant medication in continuation treatment of unipolar major depression."
The conclusion of the study was this:
CONCLUSIONS: Lithium augmentation in the continuation phase of treatment of unipolar major depressive disorder effectively protects patients against a relapse. Patients who respond to lithium augmentation should be maintained on lithium augmentation for a minimum of 6 months or even longer.
So I'm wondering whether that document has enough authority for me to be convinced that both my doctor and the guy in therapy are wrong? Or do I need further proof?
What do you guys at babble know about lithium as an augmenting agent?
I was also upset at the guy in the therapy because he seems to talk with a lot of authority about things he doesn't know much about, so if he happens to be wrong, I will have to address that in the group, as that is what we do in therapy. So I'd like to get good info on this matter.
Thanks in advance for any info or suggestion.
Posted by Phillipa on September 25, 2008, at 21:05:59
In reply to Lithium to agument SSRI's in unipolar depressives?, posted by Girlnterrupted78 on September 25, 2008, at 19:48:33
Well all I know is I've seen a lot of alchoholics respond positiviely to lithium especially angry ones calmed them right down and the appeared less stressed. If they drank cause they were depressed I would think it could be true. Phillipa
Posted by desolationrower on September 25, 2008, at 21:31:13
In reply to Re: Lithium to agument SSRI's in unipolar depressives? » Girlnterrupted78, posted by Phillipa on September 25, 2008, at 21:05:59
It has been used for a while to augment mostly TCAs. There is less evidence for use with sris, but it does appear to help too. It isn't a preferred option (at least in actual practice; it is usually recommended as a 2nd or 3rd line option by 'opinion leader' types) because it has significant side effects, generally requires some blood monitoring, and other options like 2nd antidepressant like bupripion or mirtazapine, thyroid, or just switching antidepressants to a new one also work. It does annoy me when 'authority' types make dumb conclusory statements. it sounds really frustrating.
Also, i couln't open your link, but that sounds like the sort of study that exists. single studies are not always enough to make a treatement decision; here is a review of a number of studies about lithium augmentation, hope it helps. http://server03.cpa-apc.org:8080/Publications/archives/cjp/2003/august/bauer.pdf
-d/r
Posted by azalea on September 25, 2008, at 23:32:01
In reply to Lithium to agument SSRI's in unipolar depressives?, posted by Girlnterrupted78 on September 25, 2008, at 19:48:33
You're absolutely correct! Lithium is used an augmenting agent in unipolar depression. Way to go doing your own research. You might consider bringing the article to group. If you're not responding well to Celexa, augmentation is a valid strategy. Lamictal (lamotrigine) has also been studied to augment response in treatment resistant unipolar depression. It has fewer side effects and doesn't require blood draws to monitor blood levels.
>
> I am currently doing group therapy and seeing a new psychiatrist. I'm taking Celexa 20mgs (after a horrible year on Nardil) and the 20mgs is doing very little, and if I raise it to 40mgs, it gives me a horrible stiff neck and jaw.
>
> So anyway, I read an article that I found at my clinic where the author, an MD/psychopharmacologist, recommended lithium to augment/potentiate an AD.
>
> I mentioned this to my psychiatrist, and he said that those kinds of reading materials ( offered by the actual clinic!) were not to be taken seriously.
>
> Then I brought this up in group therapy, and even showed them the pamphlet I read, and one of the guys in therapy spoke with a lot confidence and even authority! on the matter, and said absolutely not, lithium is only to treat bipolar disorder, and there's NO WAY I should use it to augment or otherwise.
>
> Then I went online and found this:
>
> http://www.ncbi.nlm.nih.gov/pubmed/10964859?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed
>
> "Double-blind, placebo-controlled trial of the use of lithium to augment antidepressant medication in continuation treatment of unipolar major depression."
>
> The conclusion of the study was this:
>
> CONCLUSIONS: Lithium augmentation in the continuation phase of treatment of unipolar major depressive disorder effectively protects patients against a relapse. Patients who respond to lithium augmentation should be maintained on lithium augmentation for a minimum of 6 months or even longer.
>
> So I'm wondering whether that document has enough authority for me to be convinced that both my doctor and the guy in therapy are wrong? Or do I need further proof?
>
> What do you guys at babble know about lithium as an augmenting agent?
>
> I was also upset at the guy in the therapy because he seems to talk with a lot of authority about things he doesn't know much about, so if he happens to be wrong, I will have to address that in the group, as that is what we do in therapy. So I'd like to get good info on this matter.
>
> Thanks in advance for any info or suggestion.
Posted by Emily Elizabeth on September 26, 2008, at 22:24:56
In reply to Re: Lithium to augment SSRI's in unipolar depressi » Girlnterrupted78, posted by azalea on September 25, 2008, at 23:32:01
I can't believe your pdoc dismissed this option!
Li has been one of the most widely studied augmentation strategies. It is known to be particularly good for reducing suicidal thoughts.I added it to an SSRI (Lexapro) and found it helpful (although it did not help as much as I needed it to). A lot of people are afraid of Li, but really it is a good drug.
Good luck.
Best,
EE
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