Lithium antidepressants with

Augmenting antidepressants with lithium has repeatedly been shown to be effective. But lithium is a difficult medication to take. It is very dangerous in overdose and can quickly reach toxic levels due to fluid loss from diarrhea, profuse sweating, or high fevers. Even at treatment levels, lithium can produce unpleasant side effects such as dizziness, frequent urination, and tremors. Despite all its problems, lithium... 

Antidepressant treatment has, in recent studies, been shown to upregulate the cyclic adenosine monophosphate (cAMP) response element binding protein (CREB) cascade and expression of BDNF [59]. This upregulation of CREB and BDNF raises the possibility that antidepressant treatment could oppose the cell death pathway, possibly via increased expression of the oncogene Bcl-2. Studies are necessary to determine if antidepressant treatment increases Bcl-2 expression. Increased expression of Bcl-2 in brain and cultured cells, and inhibition of apoptosis of cultured cerebellar granule neurons have been reported with lithium treatment [57]. Mice lacking the BDNF TrkB receptor fail to show behavioral and neurogenic responses to antidepressants. 

Lamotrigine is effective for the maintenance treatment of bipolar I disorder in adults. It has both antidepressant and mood-stabilizing effects, and it may have augmenting properties when combined with lithium or valproate. It has low rates of switching patients to mania. Although it is less effective for acute mania compared to lithium and valproate, it may be beneficial for the maintenance therapy of treatment-resistant bipolar I and II disorders, rapidcycling, and mixed states. It is often used for bipolar II patients. 

If we dehne a mood stabilizer as a medication that is both an effective anti-manic and antidepressant, then lithium arguably remains to this day the prototypical mood stabilizer. Lithium not only reduces the symptoms of acute BPAD, it also prevents the recurrence of additional mood episodes. Despite the fact that lithium has revolutionized the treatment of BPAD and remains nearly 50 years after its introduction as the single best treatment for many patients with BPAD, there is still no consensus as to how it works. Lithium exerts effects on several neurotransmitter systems (e.g., serotonin, dopamine, norepinephrine, acetylcholine), on second messenger systems inside the nerve cell, and on nerve cell gene expression. Yet, precisely how these varied effects produce lithium s therapeutic benefit remains unclear. 

Schizoaffective disorders have depression or mania as a major component in addition to psychosis. Thus, lithium or an antidepressant may have to be added to the regimen. Antipsychotic agents are also used in the initial therapy of mania because the patient s response is more rapid than with lithium. As the condition subsides, the antipsychotic can be withdrawn. 

Like some other antidepressants and lithium, the MAOIs can also cause weight gain. Because they do not affect cholinergic receptors, they produce less constipation, dry mouth, and blurred vision, typically associated with the tricyclics. MAOIs do produce some similar adverse effects, particularly urinary hesitancy, possibly because... 

The use of electrical stimulation to induce therapeutic seizures is the safest and most efficient form of convulsive therapy (e.g., as compared with pharmacoconvulsive therapy). In 1938, Cerletti and Bini ( 3) were the first to attempt this approach, and until the introduction of effective pharmacotherapy, ECT remained the primary treatment for more severe mood and psychotic episodes. Since then, however, this somatic therapy has been relegated to a secondary role, usually attempted after trials with standard psychotropics (e.g., antidepressants, antipsychotics, lithium, and other mood stabilizers, often in multiple combinations) have proved inadequate. 

Garland EJ, Remick RA, Zis AP. Weight gain with antidepressants and lithium. J Clin Psychopharmacol 1988 8 323-330. 

Schizoaffective disorder, another condition with an affective component characterized by a mixture of schizophrenic symptoms and depression or excitement, is treated with antipsychotic drugs alone or combined with lithium. Various antidepressants are added if depression is present. 

Antidepressants modify the long-term course of bipolar disorder as well. When given with lithium or other mood stabilizers, they may reduce depressive episodes. Interestingly, however, antidepressants can flip a depressed bipolar patient into mania, into mixed mania with depression, or into chaotic rapid cycling every few days or hours, especially in the absence of mood stabilizers. Thus, many patients with bipolar disorders require clever mixing of mood stabilizers and antidepressants, or even avoidance of antidepressants, in order to attain the best outcome. 

Incompatibilities of metoclopramide depend on drug concentration, pH, and temperature. It is incompatible with cephalosporins, chloramphenicol, sodium bicarbonate, doxorubicin, cisplatin, and cyclophosphamide. Caution should be exercised with simultaneous administration of metoclopramide with lithium, sym-pathomimetics, antidepressants, bromocriptine, and carbamazepine. Omperazole interacts with tolbutamide, clarithromycin, and phenytoin. Coadministration of rantidine and cisapride increases the plasma concentration of rantidine. Abuse of senna laxative has been reported and may cause hepatitis.176-178... 

Rosenbaum, A., Maruta, T., Duane, D., Auger, R., Martin, D., Brenengen, E. (1980). Tardive dyskinesia in depressed patients Successful therapy with antidepressants and lithium. Psychosomatics, 21, 715-719. 

The role of lamotrigine in the treatment of bipolar disorder has been reviewed, and combination therapy with lamotrigine plus other mood stabilizers, including lithium, has been particularly discussed (81). Lamotrigine has a favorable tolerability profile compared with lithium, but lithium has better antimanic effects than lamotrigine, which exerts its antidepressant effects sooner than lithium. 

Bupropion has about the same seizure potential as tricyclic antidepressants (SEDA-8, 30), but the manufacturers noted an increased risk of seizures in patients taking over 600 mg/day in combination with lithium or neuroleptic drugs (SEDA-10, 20). 

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