title: Comparison of lithium, aripiprazole and olanzapine as augmentation to paroxetine for inpatients with major depressive disorder.
abstract: BACKGROUND
  Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatments for major depressive disorders (MDD). It has been reported, however, that 30-40% of patients with MDD who received SSRIs failed to respond to treatment. Use of lithium (Li) to augment SSRIs seems to be the most common strategy in such cases. It was recently demonstrated that atypical antipsychotics are effective augmentation agents in MDD. Here, we present a randomized controlled study that compared augmentation with Li, olanzapine (OLA) or aripiprazole (ARI) in paroxetine-refractory patients with MDD.
  
  
  METHODS
  Participants were 30 patients who met Diagnostic and Statistical Manual of Mental Disorders IV criteria for MDD and refractory to paroxetine treatment. Treatment with Li, OLA or ARI was added to paroxetine in a randomized protocol for 4 weeks. We defined the patients whose scores on the Hamilton Rating Scale for Depression decreased 50% or more as responders.
  
  
  RESULTS
  Two patients dropped out because of adverse effects. Response rates to Li, OLA or ARI augmentation were 4/10 (40%), 3/10 (30%) and 4/10 (40%), respectively. In addition, Li, OLA and ARI did not influence plasma paroxetine concentrations.
  
  
  CONCLUSIONS
  We concluded that OLA or ARI could be used as alternatives to Li as options for patients who do not respond to paroxetine treatment.
authors: Department of Psychiatry, University of Occupational and Environmental Health, 1-1Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 80785555, Japan.
authors: Reiji
authors: R
authors: Yoshimura
authors: University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
authors: Hikaru
authors: H
authors: Hori
authors: University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
authors: Wakako
authors: W
authors: Umene-Nakano
authors: University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
authors: Atsuko
authors: A
authors: Ikenouchi-Sugita
authors: University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
authors: Asuka
authors: A
authors: Katsuki
authors: University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
authors: Kiyokazu
authors: K
authors: Atake
authors: University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
authors: Jun
authors: J
authors: Nakamura
keywords: aripiprazole; augmentation; lithium; major depressive disorder olanzapine; paroxetine