Lithium augmentation in geriatric depressed outpatients: A clinical report

Lithium augmentation of antidepressant therapy in elderly outpatients has not been systematically assessed. A prospective, practice‐based observational study of 44 patients comparing an antidepressant monotherapy group ( N = 23) with a lithium augmentation group ( N = 21) was conducted in a geriatric psychiatry, outpatient clinic. The severity of depression was evaluated with the Montgomery–Asberg Depression Rating Scale (MADRS), the DSM‐III‐R Global Assessment of Functioning (GAF), a treatment effectiveness rating (ER) and the Geriatric Depression Scale (GDS). Patient‐reported adverse events were systematically collected. The mean age for the group was 76.5 ± 6.0 years, 81.8% were female and the most common principal diagnosis was major depression (88.6%). Doxepin was the most commonly prescribed antidepressant (29.5%), followed by nortriptyline (27.2%) and phenelzine (15.9%). Patients receiving lithium augmentation were less depressed and functioning better than those in the antidepressant alone treatment group—MADRS: 8.5 ± 8.8 vs 13.9 ± 9.0 ( p < 0.05); GAF: 77.9 ± 8.3 vs 68.5 ± 10.5 ( p < 0.01); ER: X 2 = 4.5 ( p < 0.05); GDS: 4.0 ± 2.7 vs 5.9 ± 4.3 (NS). Patients in the lithium group tended to report fewer adverse events (3.7 ± 2.1 vs 5.0 ± 3.0 (NS)). Results suggest that lithium augmented patients are less depressed and report fewer adverse events than those on antidepressants alone. Lithium appears to be a safe and effective addition to antidepressant pharmacotherapy in the elderly.