A meta-analysis of the controlled clinical trials comparing the efficacy of combined lithium-imipramine therapy with each drug alone in the prevention of relapse in patients with unipolar depressive illness shows the combination to be superior to lithium alone (for any relapse, p < 0.05; for specifically depressive relapse, p < 0.025) and imipramine alone (for any relapse, p < 0.025; for specifically depressive relapse, p < 0.05). The issue of statistical power in studies of this kind is discussed. A single case of unipolar depressive illness is described, in which combined lithiumtranylcypromine therapy was superior to either drug alone. A combination of lithium and an antidepressant should be considered for any patient suffering from this condition who fails to remain well on either drug alone.
References
1.
Consenus Development Panel.Mood disorders: pharmacologic prevention of recurrences.Am J Psychiatry1985; 142: 469–476.
2.
LehmannH.E.Clinical evaluation and natural course of depression.J Clin Psychiatry1983; 44: 5–10.
3.
PaykelE.S., DimascioA., HaskellD.Effects of maintenance amitriptyline and psychotherapy on symptoms of depression.Psychol Med1975; 5: 67–77.
4.
DavisJ.M.Overview: maintenance therapy in psychiatry. II. Affective disorders.Am J Psychiatry1976; 133: 1–13.
5.
KlermanG., DimascioA., WeissmanM.Treatment of depression by drugs and psychotherapy.Am J Psychiatry1974; 132: 186–191.
6.
MindhamR.H.S., HowlandC., ShepherdM.An evaluation of continuation therapy with tricyclic antidepressants in depressive illness.Psychol Med1973; 3: 5–17.
7.
CoppenA., GhoseK., MontgomeryS.Continuation therapy with amitriptyline in depression.Br J Psychiatry1978; 133: 28–33.
8.
SteinM.K., RickelsK., WeiseC.C.Maintenance therapy with amitriptyline: a controlled trial.Am J Psychiatry1980; 137: 370–371.
9.
KleinmanI., AnanthJ.Tricyclic continuation and maintenance therapy in unipolar depression.Psychosomatics1981; 22: 1031–1036.
10.
MeliaP.I.Prophylactic lithium: a double-blind trial in recurrent affective disorders.Br J Psychiatry1970; 116: 621–624.
11.
BaastrupP.C., PoulsenJ.C., SchouM.Prophylactic lithium: double blind discontinuation in manic depressive and recurrent-depressive disorders.Lancet1970; 2: 326–330.
HullinR.P., McDonaldR., AllsoppM.N.E.Prophylactic lithium in recurrent affective disorders.Lancet1972; 2: 1044–1046.
14.
CundallR.L., BrooksP.W., MurrayL.G.A controlled evaluation of lithium prophylaxis in affective disorders.Psychol Med1972; 2: 308–311.
15.
PerssonG.Lithium prophylaxis in affective disorders.Acta Psychiatr Scand1972; 2: 308–311.
16.
HullinR.P., McDonaldR., AllsoppM.N.E.Further report on prophylactic lithium in recurrent affective disorders.Br J Psychiatry1975; 126: 281–284.
17.
FieveR.R., DunnerD.L., KumbarachiT.Lithium carbonate in affective disorders.Arch Gen Psychiatry1975; 32: 1541–1544.
18.
PrienR.J.Lithium in the prophylactic treatment of affective disorder.Arch Gen Psychiatry1979; 36: 847–848.
19.
CoppenA., Abou-SalehM.T.Lithium in the prophylaxis of unipolar depression: a review.J R Soc Med1983; 76: 297–301.
20.
KaneJ.M., QuitkinF., RifkínA.Lithium carbonate and imipramine in the prophylaxis of unipolar and bipolar II illness.Arch Gen Psychiatry1982; 39: 1065–1068.
21.
PrienR.F., KupferD., ManskyP.A.Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders.Arch Gen Psychiatry1984; 41: 1096–1104.
22.
PeselowE.D., DunnerD., FieveR.R.Maintenance treatment of unipolar depression.Psychopharmacol Bull1981; 17: 53–56.
PrienR.F., KupferD.J.Continuation drug therapy for major depressive episodes: how long should it be maintained?Am J Psychiatry1986; 143: 18–23.
25.
SpitzerR., EndicottJ., RobinsE.Research Diagnostic Criteria for a selected group of functional disorders.New York: Biometrics Division, New York State Psychiatric Institute,1975.
26.
FeinsteinA.R.Sample size and the other side of statistical significance. In: FeinsteinA.R., ed. Clinical biostatistics.St. Louis: C.V. Mosby Co.,1977.
27.
KraemerH.C., ThiemannS.How many subjects? Statistical power analysis in research.Newbury Park, California: Sage Publications, 1987.
28.
RosenthalR.Combining results of independent studies.Psychol Bull1978; 85: 185–193.
29.
LingjaerdeO., EdlundA.H., GormsenC.A.The effect of lithium carbonate in combination with tricyclic antidepressants in endogeneous depression.Acta Psychiatr Scand1974; 50: 233–242.
30.
HimmelhochJ.M., NeilJ.F.Lithium therapy in combination with other forms of treatment. In: JohnsonF.N., ed. Handbook of lithium therapy.Lancaster: MTP Press,1980.
31.
De MontignyC., GrunbergF., MayerA.Lithium induced rapid relief of depression in tricyclic antidepressant drug non-responders.Br J Psychiatry1981; 138: 252–256.
32.
De MontignyC., CournoyerG., MorissetteR.Lithium carbonate addition in tricyclic antidepressant-resistant unipolar depression.Arch Gen Psychiatry1983; 40: 1327–1334.
33.
HeningerG.R., CharneyD.S., SternbergD.E.Lithium carbonate augmentation of antidepressant treatment.Arch Gen Psychiatry1983; 40: 1335–1342.
34.
LouieA.K., MeltzerH.Y.Lithium potentiation of antidepressant treatment.J Clin Psychopharmacol1984; 4: 316–321.
35.
MadakasiraS.Low dose potency of lithium in antidepressant augmentation.Psych J Univ Ottawa1986; 11: 107–109.
36.
PriceL., CharneyD.S., HeningerG.R.Variability of response to lithium augmentation in refractory depression.Am J Psychiatry1986; 143: 1387–1392.
37.
ZallH.Lithium carbonate and isocarboxazid — an effective drug approach in severe depressions.Am J Psychiatry1971; 127: 1400–1403.
38.
NelsonJ.C., ByckR.Rapid response to lithium in phenelzine non-responders.Br J Psychiatry1982; 141: 85–86.
39.
TariotP., MurphyD.L., SunderlandT.Rapid antidepressant effect of addition of lithium to tranylcypromine.J Clin Psychopharmacol1986; 6: 165–167.
40.
HimmelhochJ.M., DetreT., KupferD.J.Treatment of previously intractable depressions with tranylcypromine and lithium.J Nerv Ment Dis1972; 155: 216–220.
41.
PriceL.H., CharneyD.S., HeningerG.R.Efficacy of lithium-tranylcypromine treatment in refractory depression.Am J Psychiatry1985; 142: 619–623.
42.
FeinS., PazV., RaoN.The combination of lithium carbonate and an MAOI in refractory depressions.Am J Psychiatry1988; 145: 249–250.
BunneyW.E.Jr, Garland-BunneyB.L.Mechanisms of action of lithium in affective illness: basic and clinical implications. In: MeltzerH.Y., ed. Psychopharmacology — the third generation of progress.New York: Raven Press,1987.
