1 International Consortium for Mood and Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.
3 Early Intervention Program, J Horwitz Psychiatric Institute, Santiago, Chile.
J Psychopharmacol. 2019 Feb;33(2):167-176. doi: 10.1177/0269881118822161. Epub 2019 Jan 30.
The potential value of lithium treatment in particular aspects of unipolar major depressive disorder remains uncertain.
With reports of controlled trials identified by systematic searching of Medline, Cochrane Library, and PsycINFO literature databases, we summarized responses with lithium and controls followed by selective random-effects meta-analyses.
We identified 36 reports with 39 randomized controlled trials: six for monotherapy and 12 for adding lithium to antidepressants for acute major depression, and 21 for long-term treatment. Data for monotherapy of acute depression were few and inconclusive. As an adjunct to antidepressants, lithium was much more effective than placebo ( p<0.0001). For long-term maintenance treatment, lithium was more effective than placebo in monotherapy ( p=0.011) and to supplement antidepressants ( p=0.038), and indistinguishable from antidepressant monotherapy.
The findings indicate efficacy of lithium as a treatment for some aspects of major depressive disorder, especially as an add-on to antidepressants and for long-term prophylaxis. It remains uncertain whether some benefits of lithium treatment occur with many major depressive disorder patients, or if efficacy is particular to a subgroup with bipolar disorder-like characteristics or mixed-features.
锂治疗单相重性抑郁障碍某些方面的潜在价值仍不确定。
通过系统检索 Medline、Cochrane 图书馆和 PsycINFO 文献数据库，我们汇总了锂治疗组和对照组的报告，随后进行了选择性随机效应荟萃分析。
我们确定了 36 份报告，其中包含 39 项随机对照试验：6 项用于单药治疗，12 项用于将锂添加到抗抑郁药中治疗急性重性抑郁症，21 项用于长期治疗。急性抑郁症单药治疗的数据很少且不确定。作为抗抑郁药的辅助治疗，锂比安慰剂更有效（p<0.0001）。对于长期维持治疗，锂比安慰剂（p=0.011）和补充抗抑郁药（p=0.038）更有效，与抗抑郁药单药治疗无区别。
这些发现表明锂对重性抑郁障碍的某些方面具有治疗作用，尤其是作为抗抑郁药的辅助治疗和长期预防。目前仍不确定锂治疗的某些益处是否发生在许多重性抑郁障碍患者中，或者疗效是否特定于具有双相障碍样特征或混合特征的亚组。
