Adli Mazda, Bschor Tom, Bauer Michael, Lucka Claudia, Lewitzka Ute, Ising Marcus, Uhr Manfred, Mueller-Oerlinghausen Bruno, Baethge Christopher
Department of Psychiatry and Psychotherapy, Charité - Universitatsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
Neuropsychobiology. 2009;60(1):23-30. doi: 10.1159/000234814. Epub 2009 Aug 14.
Lithium augmentation is a first-line strategy for depressed patients resistant to antidepressive therapy, but little is known about patients' subsequent long-term course or outcome predictors. We investigated long-term outcomes of unipolar depressed patients who had participated in a study on the effects of lithium augmentation on the hypothalamic-pituitary-adrenocortical system using the combined dexamethasone/corticotrophin-releasing hormone (DEX/CRH) test.
Twelve to 28 months (mean 18.6 +/- 4.6 months) after lithium augmentation, 23 patients were assessed with a standardized interview, of which 18 patients had complete DEX/CRH test results. Relapse was diagnosed by DSM-IV criteria (Structured Clinical Interview for DSM-IV; SCID I).
Only 11 patients (48%) had a favorable follow-up, defined as absence of major depressive episodes during the observation period. Patients with a favorable and an unfavorable course did not differ in clinical or sociodemographic parameters, endocrinological results or continuation of lithium. However, fewer previous depressive episodes tended to correlate (p = 0.09) with a favorable course.
Results from studies using the DEX/CRH test to predict relapse in depressed patients treated with antidepressants were not replicated for lithium augmentation. Our finding could reflect the elevation of DEX/CRH results by lithium, independent of clinical course. Limitations of the study are its small sample size, the heterogeneous clinical baseline conditions and the lack of lithium serum levels. The fact that lithium continuation did not predict the course might be related to the difference between the efficacy of lithium in controlled studies and its effectiveness in naturalistic settings.
锂盐增效是对抗抑郁治疗耐药的抑郁症患者的一线治疗策略，但对于患者随后的长期病程或预后预测因素知之甚少。我们使用联合地塞米松/促肾上腺皮质激素释放激素（DEX/CRH）试验，调查了参与锂盐增效对下丘脑-垂体-肾上腺皮质系统影响研究的单相抑郁症患者的长期预后。
锂盐增效后12至28个月（平均18.6±4.6个月），对23例患者进行标准化访谈评估，其中18例患者有完整的DEX/CRH试验结果。根据《精神疾病诊断与统计手册》第四版标准（《精神疾病诊断与统计手册》第四版结构化临床访谈；SCID I）诊断复发。
只有11例患者（48%）随访情况良好，定义为观察期内无重度抑郁发作。随访情况良好和不佳的患者在临床或社会人口统计学参数、内分泌学结果或锂盐持续使用情况方面无差异。然而，既往抑郁发作次数较少往往与随访情况良好相关（p = 0.09）。
使用DEX/CRH试验预测抗抑郁药治疗的抑郁症患者复发的研究结果，在锂盐增效治疗中未得到重复。我们的发现可能反映了锂盐使DEX/CRH结果升高，与临床病程无关。本研究的局限性在于样本量小、临床基线条件异质性以及缺乏锂盐血清水平。锂盐持续使用不能预测病程这一事实，可能与锂盐在对照研究中的疗效与其在自然环境中的有效性之间的差异有关。
