Combination of Lithium and Duloxetine in 2 Depressed Patients Refractory to Duloxetine Monotherapy

Duloxetine, an inhibitor of both norepinephrine and serotonin transporters (SNRI), is a safe and effective pharmaceutical in acute, adult major depressive disorder [1], but does not exert better effects than standard alternatives [2]. In general, 30–40% of depressed patients do not respond to the first course of drug treatment, and more than 50% of initial non-responders also do not respond to a second, different antidepressant agent [3]. There is good evidence for efficacy of lithium in combination with various antidepressant drugs in therapy-resistant depression. In a recent meta-analysis of 10 randomized placebo-controlled trials, the addition of lithium to an antidepressant therapy had a statistically significant effect compared to the addition of placebo [4]. The therapeutic potential of a combination of an antidepressant with lithium is probably mediated through the serotonergic system [5] and has been demonstrated for tricyclic antidepressants [6], selective serotonin reuptake inhibitors (SSRI) [7] [8] [9] and the selective serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine [8] [10]. Regarding the combination of the SNRI duloxetine and lithium, there are no published data either on efficacy or on safety. This is the first report of the successful addition of lithium to duloxetine in 2 patients with therapy-refractory severe depression.

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