| Summary: | The study assessed the evidence for the efficacy of lithium in the acute treatment of prophylaxis of unipolar depression and as an augmentation drug in treatment resistant depression. It examined the relationship between hormonal changes, lithium discontinuation and relapse in bipolar illness. Finally, it investigated the addition of inositol in the diet of bipolar patients as an alternative treatment for lithium side effects. AIMS: 1) to assess the efficacy of lithium in unipolar depression by comparing readmission rates in patients after lithium discontinuation and in patients who continued to take lithium as a prophylactic agent, and evidence for a lithium withdrawal syndrome in unipolar patients during the first three months of discontinuation. 2) to analyze quantitatively the results of lithium trials in the acute treatment and prophylaxis of unipolar depression in order to estimate the therapeutic value of lithium by measuring an overall effect size. 3) to investigate the neuroendocrine changes involving thyroxine (T4) thyroid stimulating hormone (TSH) and cortisol before and after lithium discontinuation in bipolar patients and to test whether they are related to the withdrawal syndrome observed in these patients. 4) to evaluate the effects of adding inositol to the diet of clinically stable bipolar patients on prophylactic lithium upon thyroxine (T4) and thyroid stimulating hormone (TSH) concentrations and on other peripheral side-effects of lithium, comparing the results to those found in a group of normal controls not taking lithium. 5) to assess the efficacy of lithium augmentation in treatment resistant depression by reviewing, using quantitative techniques, the controlled trials on the topic. While the results support the case for lithium augmentation in treatment-resistant depression, there remains considerable uncertainty over the duration of treatment necessary to see and sustain a response to lithium augmentation.
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