What is lithium and how does lithium help Depression? You may know lithium as an organic element on the periodic table of elements. However, lithium is also a mood stabilizer—a drug used to treat mood disorders like bipolar disorder. Adopted by modern psychiatry in 1949, lithium medication has mainly been considered a treatment for bipolar disorder, mania, and hypomania. Lithium has also been used as an augmentation treatment for Depression.
What is Lithium Augmentation Therapy for Major Depression?
Augmentation treatment simply means that a second drug is added to an antidepressant treatment regimen. This additional drug is added when there is no response or, more commonly, only a partial response to an antidepressant.
Aside from lithium, other augmentation agents include thyroid hormones, atypical neuroleptics, and anticonvulsants like lamotrigine, stimulants, and buspirone. Although several drugs are available to treat Major Depression, at least 30-50% of people with Major Depression will not respond sufficiently to treatment with a single antidepressant.
More than 30 studies and 10 placebo-controlled double-blind trials have shown the substantial success with lithium augmentation in the acute treatment of depressive episodes. Throughout all of these studies, 5 of them did not show much improvement with Lithium augmentation, likely due to insufficient doses or too short a treatment duration. Doses of Lithium that were higher than 600 mg a day over the course of 7 days were the most effective in augmentation therapy.
Lithium salts have been used to augment antidepressants for the past 25 years. A study found that within 48 hours, 8 patients, who had previously shown no response to tricyclic antidepressants had a dramatic response to lithium salts.
A study of 29 patients with unipolar major depressive disorder received Lithium augmentation and a placebo over a 6-week period. In the placebo group, 7 of the 15 patients relapsed while none in the Lithium group experienced a relapse.
How Does Lithium Work?
Lithium’s underlying mechanism is still unclear, but possibilities include its modulation of serotonin neurotransmission and endocrine systems. From animal studies, research shows that there was an increase in serotonin levels when Lithium was added to the treatment plan along with the SSRI citalopram.
Understanding Lithium Depression Treatment Options
For patients asking “does lithium help with depression,” the evidence suggests that lithium medication can be a useful addition to an existing antidepressant regimen. Clinicians often consider lithium for Major Depression when a patient has had only a partial response to their current antidepressant, as studies consistently show that adding Lithium can produce meaningful improvement in depressive symptoms.
It is important to understand that lithium depression treatment is not a standalone approach for most patients. Rather, it functions as part of a broader treatment plan developed by a qualified psychiatrist who can monitor dosing, blood levels, and side effects closely over time.
When Should I Consider Lithium Augmentation?
When Antidepressants Aren’t Working
The nonresponse or the late onset of therapeutic response to antidepressants remains to be one of the major concerns in clinical practice. To address this concern, augmentation therapy aims to enhance treatment for Depression.
Besides late or non-response to antidepressants, there are other factors that could make lithium augmentation the route for you. Instead of switching from one antidepressant to another, adding lithium to a treatment regimen can be an alternative. Lithium augmentation eliminates the need for a transition period between antidepressants, along with the risks that may come with it.
Augmentation can also work faster than other methods and is great for patients who have had a positive partial response and don’t want to backslide in their treatment.
Benefits of Lithium for Depression
In a study with 71 depressed patients, those with more severe depressive symptoms were more likely to respond to the addition of Lithium. When lithium augmentation works for a patient, the response is usually rapid. Treatment should be continued for at least 12 months, or longer for patients with recurrent Depression.
For those researching lithium for Major Depression, it is worth noting that the strongest evidence supports its use as an add-on treatment rather than a primary antidepressant. The research on lithium Depression management indicates that patients with more severe symptoms may actually experience greater benefits from augmentation.
Side Effects of Lithium Augmentation
Although augmentation with Lithium can often be effective as evidenced in the previously discussed studies, unfortunately, Lithium medication can be a challenging drug to take due to its numerous common side effects and required routine blood tests conducted at least every 3-4 months that are required to monitor its level and to screen for the possible development of its negative impact on organs such as the Thyroid gland and the Kidneys. The most common side effects of Lithium are:
- Weakness and sedation
- Poor concentration and Cognitive Dullness
- Diarrhea
- Tremor (primarily of the hands)
- Nausea and Vomiting
- Slurred Speech
- Confusion
- Weight Gain
- Excessive Urination and Thirst
- Sexual Dysfunction
- Acne
- Psoriasis
Especially with long-term use, lithium can cause Hypothyroidism and Chronic Kidney Disease, specifically chronic tubulo-interstitial nephritis of the kidneys, which is characterized by a decrease in the glomerular filtration rate (GFR).
Weighing the Risks: Does Lithium Help With Depression Enough to Justify the Side Effects?
When patients ask “does lithium help with Depression,” the answer often depends on how they respond individually and whether they can tolerate the side effects. For some, lithium for treatment resistant Depression provides significant relief that outweighs the drawbacks. For others, the burden of regular blood monitoring and potential organ effects makes it less practical as a long-term solution.
This is why exploring the full range of available lithium Depression alternatives is so important. Patients who find that lithium for treatment resistant Depression is not the right fit still have other evidence-based options to consider.
Consider TMS Over Lithium for Major Depression
Given that Lithium has so many side effects and potential toxicities, it is important to consider other treatment options like TMS when antidepressants are not adequately relieving symptoms of Depression. Patients who have explored lithium for Major Depression without adequate results or who cannot tolerate the side effects of lithium medication may find TMS to be a safer, noninvasive alternative.
At Mid City TMS, we can help you explore alternative treatment options for treatment-resistant Major Depression. For those who have asked “does lithium help with Depression” and found the answer unsatisfactory for their situation, lithium for treatment resistant Depression is not the only path forward. Learn more about our transcranial magnetic stimulation (TMS) and join the hundreds of patients that have found relief from Depression under Dr. Bruno’s care. Contact us with any questions you have or to schedule an appointment today.