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Lithium For Treatment-Resistant Depression: An Effective Augmentation Strategy

Lithium carbonate has become a very popular augmentation option for treatment-resistant depression.  If you have treatment resistant depression, chances are that most psychiatrists have explored antidepressant monotherapy – or treatment with a single antidepressant. Once you have gone through the ringer of SSRI’s, TCA’s, and MAOI’s and found that none of the medications help your depression, what can you do? At this point, many psychiatrists may label your depression as being “treatment resistant.” In cases of treatment-resistant depression, one of the first line of treatments is augmenting an antidepressant with that of Lithium.

What is Lithium?

Lithium carbonate is a naturally occurring element that has been found to act as a mood stabilizer. Due to the mood stabilizing properties that Lithium provides, it is considered a first line of treatment for cases of Bipolar disorder. However, if you have treatment-resistant depression, your psychiatrist or doctor may consider adding Lithium to your treatment regimen. This is due to the fact that the combination of Lithium and an antidepressant is considered a “first line” of treatment for resistant depression.

Taking Lithium for Treatment-Resistant Depression

There’s really only a couple major benefits associated with taking Lithium for depression. In cases of extreme depression though, the subtle benefits that can be obtained from this medication are huge. If you are having depressive mood swings or cannot seem to get your mood stabilized, this medication may work wonders.

  • Calmness – It’s common that lithium may increase feelings of calmness. It is a mood stabilizer, so you probably won’t feel “excited” or hyper on this medication. It actually counteracts mania and helps bring your mood to a stable position.
  • Stabilized mood – The biggest benefit associated with lithium is that it can help stabilize your mood. In other words, if you are feeling excessively depressed, it will help bring your mood back up. This may be what you need to pull yourself out of the black hole that is depression.

Why Lithium isn’t used for “standard” depression

Lithium isn’t used in cases of standard depression because it doesn’t generally have antidepressant properties as a standalone treatment. It is a mood stabilizer, and thus is heavily utilized to help keep people stable. In cases of bipolar disorder, this treatment is extremely beneficial for preventing manic mood swings.

Another reason that Lithium is generally avoided is because 75% of people who take it have side effects. Although most side effects are minor, for some individuals they are pretty extreme. Obviously you should determine whether the side effects outweigh the depression. In most cases people that are put on this medication to help their treatment-resistant depression need it.

  • Mood stabilizer – It isn’t an “antidepressant” by itself – it simply works to stabilize the mood. However when supplementing it, it may be beneficial to help keep someone calm.
  • Side effects – Many of the side effects associated with this medication can be unbearable. These include things like tremors, frequent urination, diarrhea, weight gain, memory issues, muscle weakness, and thyroid problems.

Supplementing Lithium with an SSRI, TCA, MAOI

There is much scientific evidence showing that lithium in conjunction with an SSRI, TCA, or MAOI will be safe and effective as an augmentation. The therapeutic levels of lithium augmentation seem to be in concentration from 0.4 to 1 mmol/L. The most studied augmentation treatment is the combination of lithium and tricyclic (TCA) antidepressants. Rarely does anyone have a severe reaction between lithium and their TCA medication. Lithium in combination with SSRI’s is also a very popular treatment method and is very well researched. The response with MAOI’s is similar to that of TCA’s.

Source: http://www.ncbi.nlm.nih.gov/pubmed/11518471

Mood stabilizers for treatment-resistant depression

Many cases of treatment-resistant depression are a result of a person having bipolar disorder in the first place. For example, Type 2 bipolar disorder may result in a person not recovering from their depressive episode for months at a time. Although you may have treatment-resistant depression without bipolar disorder, mood stabilizers have been shown to have some benefit if you are unresponsive to other monotherapy treatments. If your psychiatrist suggests that you use a mood stabilizer for your depression treatment, they will likely supplement it with a standard antidepressant.

Is Lithium safe to take for depression?

Obviously you need to determine that for yourself. If you are experiencing crazy side effects and cannot deal with them, then maybe it would be best to try something else. I am a firm believer that there is some treatment that will work for everyone out there. If you respond well to the Lithium salts treatment, it should be pretty safe to stay on. Work with your psychiatrist and/or other doctor to determine whether you should stay on this medication for your treatment-resistant depression.

Source: http://journals.lww.com/psychopharmacology/Abstract/1999/10000/Lithium_Augmentation_in_Treatment_Resistant.6.aspx

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1 thought on “Lithium For Treatment-Resistant Depression: An Effective Augmentation Strategy”

  1. Hello, I have been on an antidepressant for over 4 months now but my depression and anxiety started again. My psychiatrist just put me on 150mg of Lithium twice daily along with my antidepressant. I am on my third day but am a extremely nauseous and have diarrhea and total loss of appetite. Is that normal? And if so, how long will this last? I do feel a bit better emotionally so I don’t want to give up.


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