[Lithium augmentation for mianserin-resistant depression in the elderly].
Depression in the elderly is characterized by a prolonged course and resistance to pharmacological treatment. Moreover, in old age sensitivity to the anticholinergic and cardiac side-effects of tricyclic antidepressants (TCA) increases. Recently new antidepressants with fewer side-effects have been developed. Of these, trazodone and mianserin have been particularly recommended for the treatment of depression in older patients. However, the effects of these new compounds on depression are similar to those of the older TCA's, leaving a substantial number of elderly patients with resistant depression. While there are many publications on the potentiation of the effect of TCA's by lithium carbonate, there is little data on the potentiation of the effects of trazodone and of mianserin by lithium, and no reports of their combined use in elderly patients. Birkhimer et al. reported a case of successful treatment of refractory depression with trazodone and lithium in a 45-year-old man. Heninger et al. successfully treated 2 treatment-refractory patients (aged 52 and 58 years, respectively) with a combination of mianserin and lithium. Price et al. reported that 85% of 12 drug-resistant patients improved when treated with lithium and mianserin, but only 22% of 9 patients treated with lithium and trazodone. We report a 73-year-old man with resistant depression whose physical condition contraindicated tricyclic antidepressants, in whom the combination of mianserin and lithium was both safe and effective.
Schreiber
S
S
Dept. of Psychiatry, Hadassah-University Hospital, Ein Karem, Jerusalem.
Shalev
A
A
D000368:Aged; D003863:Depression / Q000188:drug therapy*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008297:Male; D008803:Mianserin / Q000627:therapeutic use*
D008803:Mianserin; D008094:Lithium