Hardy B G, Shulman K I, Zucchero C
Department of Pharmacy, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
J Clin Psychopharmacol. 1997 Feb;17(1):22-6. doi: 10.1097/00004714-199702000-00005.
Recently, the therapeutic benefit of lithium augmentation in old age has come into question. These data, in light of the documented high incidence of side effects after lithium use in elderly patients, resulted in the design of a prospective, placebo-controlled lithium augmentation withdrawal study in elderly patients with unipolar depression. Twelve eligible geriatric patients (10 women and 2 men; mean [+/-SD] age, 76.2 +/- 5.7 years) with DSM-III-R unipolar depression receiving adjunct lithium therapy were randomized to receive continued lithium augmentation or matching placebo (withdrawal rate 150 mg/day/wk). At each clinic visit, patients were assessed for depression (Montgomery-Asberg Depression Rating Scale and Geriatric Depression Rating Scale) and lithium-induced toxicities (a 21-item side-effect checklist, renal and thyroid biochemistry). Over the 2-year observation period, the placebo group reported a decrease in composite 21-item side-effect score and specific lithium toxicities (e.g., urinary urgency, hand tremor, and renal/thyroid abnormalities). Two patients in the lithium maintenance group had a recurrence of depression at 61 and 96 weeks, respectively, immediately after a stressful life event (cerebrovascular accident [CVA] or death of spouse), and two patients had a recurrence in the placebo group at 7 and 92 weeks, respectively, without any apparent changes in life stresses. No other prognostic risk factors for recurrence were identified. Depression that recurred in patients who were receiving placebo was relatively resistant to reinstitution of lithium augmentation therapy. In otherwise stable geriatric patients with unipolar depression, the documented benefits of reduced side effects should be weighed against the risk of recurrence and subsequent lithium resistance before withdrawal of lithium augmentation.
最近，老年患者使用锂盐增效疗法的治疗益处受到质疑。鉴于有文献记载老年患者使用锂盐后副作用发生率很高，因此设计了一项前瞻性、安慰剂对照的锂盐增效撤药研究，针对老年单相抑郁症患者。12名符合条件的老年患者（10名女性和2名男性；平均[±标准差]年龄为76.2±5.7岁），患有DSM-III-R单相抑郁症且正在接受锂盐辅助治疗，被随机分为继续接受锂盐增效治疗或匹配的安慰剂治疗（撤药速率为150mg/天/周）。每次门诊就诊时，对患者进行抑郁评估（蒙哥马利-艾斯伯格抑郁评定量表和老年抑郁评定量表）以及锂盐诱导的毒性评估（一份包含21项的副作用清单、肾脏和甲状腺生化指标）。在2年的观察期内，安慰剂组报告21项副作用综合评分及特定锂盐毒性（如尿急、手抖和肾脏/甲状腺异常）有所下降。锂盐维持治疗组的两名患者分别在61周和96周出现抑郁复发，均在经历应激性生活事件（脑血管意外[CVA]或配偶死亡）后不久，安慰剂组也有两名患者分别在7周和92周复发，生活压力并无明显变化。未发现其他复发的预后风险因素。接受安慰剂治疗的患者复发的抑郁症对重新使用锂盐增效疗法相对耐药。在其他方面稳定的老年单相抑郁症患者中，在停用锂盐增效治疗之前，应权衡已记录的副作用减少的益处与复发风险及随后的锂盐耐药风险。
