Lithium Carbonate Versus Cognitive Therapy as Sequential Combination Treatment Strategies in Partial Responders to Antidepressant Medication: An Exploratory Trial
Sidney H. Kennedy, MD, FRCPC; Zindel V. Segal, PhD,CPsych; Nicole L. Cohen, MA; Robert D. Levitan, MD, FRCPC; Michael Gemar, PhD; and R. Michael Bagby, PhD, CPsych
Background: Partial antidepressant response is
associated with increased rates of relapse. Despite increasing
evidence that full symptomatic remission is the optimal goal of
antidepressant therapy, there have been few comparisons between
disparate treatment approaches to achieve this goal.
Method: Forty-four patients with DSM-IV major
depressive disorder (MDD) who had a partial response (17-item
Hamilton Rating Scale for Depression [HAM-D-17] score of 8-15)
during open-label antidepressant treatment for 8 to 14 weeks were
randomly assigned to receive cognitive therapy (CT) or lithium
augmentation (LA) for a further 8 weeks using a single-blind
design. Antidepressant medication was continued throughout the
study. Subjects were also reassessed 4 weeks after
discontinuation of LA or CT. Patients were enrolled in this study
beginning September 1996 and follow-up for all patients was
completed in December 2000.
Results: Although LA or CT did not significantly
decrease symptom severity during sequential combination therapy,
there was a significant decrease in HAM-D-17 scores 4 weeks later
in LA-treated subjects compared with CT-treated subjects (p =
.04). This resulted in 32% of patients achieving remission
status, although between-group differences were not significantly
different (38% in the LA group compared with 26% in the CT group,
p = .39).
Conclusion: Despite methodological limitations,
this preliminary study provides justification for both
combination treatments. An adequately powered, randomized,
controlled trial to evaluate the relative merits of combination
psychotherapy and augmentation of pharmacotherapy in patients
with partially remitted MDD is required.
J Clin Psychiatry 2003;64(4):439-444
© Copyright 2003 Physicians Postgraduate Press, Inc.