PubMed · 7140569
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R Seifert. 1982-12-03. [Lithium therapy].. https://doi.org/10.1055/s-2008-1070220
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We report on the successful treatment of two female patients with psychotic depression with the new atypical neuroleptic drug olanzapine. A 75-year-old female inpatient suffering from recurrent endogenous depression with tactile hallucinations and coenesthesia was refractory to a systematic sequential antidepressant treatment strategy during a 39-week period. After addition of the new atypical neuroleptic olanzapine to the SSRI citalopram, she showed immediate and ongoing symptom relief. In the second case of a 57-year-old female inpatient suffering from delusional depression, we observed marked symptom relief and correction of the delusions of impoverishment. Olanzapine is discussed with regard to its receptor-binding profile (antagonism to 5-HT2A- and D1-D4 receptors) as a potential neuroleptic drug in the treatment of affective disorders with psychotic symptoms.
There is not an accepted definition of severe depression, but using cut-off scores on rating scales severe depression is considered to lie at one extreme of a continuum of severity. The evidence from epidemiological, biological, and clinical efficacy studies does not support severe depression as a separate illness category. A good response to antidepressants is seen in both moderate and severe depression. The available evidence supports the view that in most cases an effective antidepressant in moderate depression is likely to have efficacy in severe depression. Few studies have found differences between antidepressants in their efficacy in treating severe depression. Most evidence of differential efficacy derives from studies of clomipramine, which is perceived as a particularly potent antidepressant by many clinicians. Other tricyclic antidepressants do not appear to have an advantage in severe depression. Separate studies to demonstrate efficacy in severe depression are not necessary for the registration of a new antidepressant. However if efficacy in severe depression is demonstrated in separate studies this information could be included in the summary of product characteristics to provide guidance to clinicians.
Lithium is widely used in the acute and prophylactic treatment of affective disorders. Lithium affects thyroid hormone metabolism via different mechanisms. In patients this leads to a compensatory increase in pituitary thyroid stimulating hormone (TSH) which usually maintains the euthyroid status. This is probably the reason for the relatively high prevalence of goitre in lithium-treated patients; however, the enlargement of the gland is only moderate in most cases. Due to its immunostimulating effects lithium may support the appearance of thyroid auto-antibodies and the development of thyroiditis, which may be the reason for a higher prevalence of hypothyroidism in patients receiving lithium. However, also cases of hyperthyroidism in such patients have been reported repeatedly. Therapeutic recommendations for the treatment of disturbances of thyroid function during lithium treatment are given.