Outcome in refractory depression.
BACKGROUND
Failure to respond to first-line antidepressant treatment can occur in up to 40% of patients with depressive illness. A proven strategy for managing this refractory depression is lithium augmentation. The long-term outcome and optimal management of patients treated with lithium augmentation remains unclear. We describe a 4-8 year naturalistic follow-up of patients treated with lithium augmentation in two controlled studies of its efficacy in refractory depression.


METHODS
Cases were followed up with personal interview where possible, and by telephone and general practitioner contact otherwise. Lifetime clinical status was ascertained using the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L).


RESULTS
We obtained outcome data on 53 of the original eligible 76 patients. There was a good outcome in 38 (72%) patients. Good outcome was associated with a less endogenous nature of depression and an absence of previous hospitalisations.


CONCLUSIONS
There do not seem to be any specific prognostic indicators of long-term outcome to lithium augmentation beyond those recognised to be relevant in the outcome of depression generally.


CONCLUSIONS
The conclusions are limited by incomplete follow-up of the total original sample and lack of objective illness and medication data for the intervening period.
Shergill
S S
SS
Institute of Psychiatry, London, UK.
Robertson
M M
MM
Stein
G
G
Bernadt
M
M
Katona
C L
CL
D000328:Adult; D000368:Aged; D003866:Depressive Disorder / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome
D008094:Lithium