Refractory depression: the addition of lithium to fluoxetine or desipramine

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Abstract
We carried out an open clinical study with 60 consecutive patients suffering from major depression with melancholia who were resistant to anti‐depressants. After at least 6 weeks of desipramine (DMI) or fluoxetine (FX) without improvement, lithium carbonate was added to the anti‐depressant. Semistructured clinical interviews using the 7‐point Clinical Global Impression Scale and 90‐item Symptom Checklist were done at baseline and weeks 1, 6 and 14. Following the addition of lithium, more patients on FX improved within the first week than those on DMI. However, with FX, 6 relapses occurred during the 2 months of follow‐up and none with DMI. The unified serotonergic and noradrenergic hypothesis for the antidepressant action could be relevant in drug‐refractory depression and should be studied further.