title: The effectiveness of lithium augmentation of milnacipran: preliminary data using the modified Japanese Psychopharmacology Algorithm.
abstract: Medication algorithms based on the best evidence available together with expert consensus are considered to promote logical consistent clinical decision making in the choice of antidepressant drugs. We report our preliminary results using the modified algorithm established by the Japanese Psychopharmacology Algorithm Project (JPAP). Subjects were 24 patients with major depressive disorders who presented to the outpatient clinic of the Department of Psychiatry at the National Defense Medical College prior to any treatment for the current episode. Ultimately, 15 patients recovered with treatment according to our protocol, including 7 who recovered upon treatment with first-line drugs; the most effective of these was paroxetine, followed by fluvoxamine and then milnacipran. Six patients recovered with second-line treatments. Among these, a combination of milnacipran and lithium was most effective, with recovery of 4 of 4 patients. We have formed a strong impression that augmentation therapy, especially with milnacipran plus lithium, is likely to be effective if the first-line antidepressant is ineffective. Investigation of more cases will be needed to confirm or refine details of the algorithm and, more generally, to determine the best approach to antidepressant medication.
authors.affiliation: Department of Psychiatry, National Defense Medical College 3-2, Namiki, Tokorozawa 359-8513, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Takehito
authors.initials: T
authors.lastname: Sawamura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Aihide
authors.initials: A
authors.lastname: Yoshino
authors.forename: Soichiro
authors.initials: S
authors.lastname: Nomura
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage* / Q000494:pharmacology; D000465:Algorithms; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000494:pharmacology; D003521:Cyclopropanes / Q000008:administration & dosage* / Q000494:pharmacology; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004357:Drug Synergism; D005260:Female; D006801:Humans; D008094:Lithium / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000494:pharmacology
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000928:Antidepressive Agents; D003521:Cyclopropanes; D008094:Lithium; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors