Lithium but not carbamazepine augments antidepressant efficacy of mirtazapine in unipolar depression: an open-label study.
BACKGROUND
The purpose of the present open-label study was to investigate the antidepressant efficacy of lithium and carbamazepine as augmentation strategies in unipolar depressed inpatients.


METHODS
Forty-six patients suffering from unipolar depression (major depressive episode according to DSM-IV criteria) were pre-treated with mirtazapine for 2 weeks initially (week -2 to week 0). Thereafter, the patients received either continuation of mirtazapine monotherapy (n = 23), combination treatment with mirtazapine and lithium (n = 13), or combination therapy with mirtazapine and carbamazepine (n = 10) for further 3 weeks (week 0 to week 3). Severity of depression was estimated weekly using the 21-item version of the Hamilton Depression Rating Scale (21-HAMD). Response was defined by a reduction of at least 50% in the 21-HAMD sum score after 3 weeks of pharmacotherapy (week 0-3).


RESULTS
Additional administration of lithium, but not adjunctive carbamazepine significantly augmented the antidepressant efficacy of mirtazapine in the unipolar depressed patients. Moreover, carbamazepine but not lithium significantly lowered the serum concentrations of mirtazapine.


CONCLUSIONS
Whereas the clinical importance of anticonvulsants in the treatment of bipolar disorder is not in doubt, the therapeutic efficacy of antiepileptic drugs such as carbamazepine is obviously limited in the pharmacotherapy of unipolar depression.
Schüle
Cornelius
C
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany. Cornelius.Schuele@med.uni-muenchen.de
Baghai
Thomas C
TC
Eser
Daniela
D
Nothdurfter
Caroline
C
Rupprecht
Rainer
R
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D018692:Antimanic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D001682:Biological Availability; D002220:Carbamazepine / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D003865:Major Depressive Disorder / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D008297:Male; D008657:Metabolic Clearance Rate; D008803:Mianserin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D008875:Middle Aged; D000078785:Mirtazapine; D055815:Young Adult
D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D018692:Antimanic Agents; D008803:Mianserin; D016651:Lithium Carbonate; D002220:Carbamazepine; D000078785:Mirtazapine