Paroxetine lithium

Alternatively, the current antidepressant may be augmented (potentiated) by the addition of another agent (e.g., lithium, T3), or an atypical antipsychotic (e.g., risperidone). Risperidone has been shown to be effective in combination with fluvoxamine, paroxetine, or citalopram in treatment-resistant depression. Olanzapine and fluoxetine have been found to be safe and effective in treatment-resistant depression. 

Concurrent administration of lithium and selective serotonin re-uptake inhibitors, such as paroxetine, results in an increased risk of central nervous system effects and lithium toxicity has been reported. 

Odagaki Y, Koyama T, Matsubara S, et al Effects of chronic lithium treatment on serotonin binding sites in rat brain. J Psychiatr Res 24 271-277, 1990 O Dwyer AM, Lightman SL, Marks MN, et al Treatment of major depression with metyrapone and hydrocortisone. J Affect Disord 33 123-128, 1995 Oehrberg S, Christiansen PE, Behnke K, et al Paroxetine in the treatment of panic disorder a randomised, double-blind, placebo-controlled study. Br J Psychiatry 167(3)374-379, 1995... 

The use of chiral lithium amides in the preparation of biologically potent piperidines from highly enriched glutarimides is illustrated in the synthesis of the antidepressant drug substance (—)-paroxetine (Figure 7)107. 

Bauer M, Zaninelli R, Muller-Oerlinghausen B, Meister W. Paroxetine and amitriptyline augmentation of lithium in the treatment of major depression a doubleblind study. J Chn Psychopharmacol 1999 19(2) 164—71. 

Serum lithium concentrations were unchanged when breakthrough depression was treated double blind by the addition of paroxetine (2CM-0 mg/day, n = 19) and the combination was generally well tolerated (23). 

Fagiolini A, Buysse DJ, Frank E, Houck PR, Luther JF, Kupfer DJ. Tolerability of combined treatment with lithium and paroxetine in patients with bipolar disorder and depression. J Clin Psychopharmacol 2001 21(5) 474-8. 

A double-blind study in which 31 patients with breakthrough depression taking lithium received augmentation with either paroxetine or amitriptyline and showed a quantitative increase in tremor activity with combined therapy, but no significant change in tremor frequency (214). 

Zaninelli R, Bauer M, Jobert M, Muller-Oerlinghausen B. Changes in quantitatively assessed tremor during treatment of major depression with lithium augmented by paroxetine or amitriptyline. J Clin Psychopharmacol 2001 21(2) 190-8. 

Activation and agitation may represent the induction of a bipolar state, especially a mixed dysphoric bipolar II condition sometimes associated with suicidal ideation, and require the addition of lithium, a mood stabilizer or an atypical antipsychotic, and/or discontinuation of paroxetine... 

Clinically important, potentially hazardous interactions with cocaine, fenfluramine, fluoxetine, fluvoxamine, lithium, MAO inhibitors, paroxetine, phenelzine, sertraline, tranylcypromine... 

Clinically important, potentially hazardous interactions with desvenlafaxine, dextromethorphan, dihydroergotamine, ephedra, ergot, fluoxetine, fluvoxamine, isocarboxazid, linezolid, lithium, MAO inhibitors, meperidine, methysergide, naratriptan, nefazodone, paroxetine, phenelzine, rizatriptan, sertraline, sumatriptan, tranylcypromine, tryptophan, venlafaxine, verapamil, zolmitriptan, zuclopenthixol... 

No significant pharmacokinetic interactions have been found to date between lithium and paroxetine. 

A woman taking imipramine, paroxetine and lithium, who had a 3-week continuous headaehe, was treated with 300 micrograms of dihydroergot-amine intravenously. Within 5 minutes of a subsequent 500-mierogram dose she developed dysarthria, dilated pupils, diaphoresis, diffuse weakness, and barely responded to eommands. She was diffusely hyperreflexie and showed oeeasional myoelonie jerks. She reeovered after 90 minutes. ... 

The concurrent use of lithium and SSRIs can be advantageous and uneventful, but various kinds of neurotoxicities have occurred in some patients. Isolated reports describe the development of symptoms similar to those of the serotonin syndrome in patients taking lithium and fluoxetine, fluvoxamine, paroxetine and possibly citalopram. In addition, increases and decreases in serum-lithium levels have been seen with fluoxetine. 

A study in 14 patients taking lithium found that tremor increased significantly when paroxetine 20 to 40 mg daily was added. The greatest increments occurred approximately 3 weeks after combined treatment was started, but tremor activity was still significantly greater than baseline after 6 weeks. No patient discontinued treatment because of the increase in tremor. ... 

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