Expert: Ivan Goldberg, M.D. - 5/5/2010

Question
How do you feel about adding lithium to an MAOI like parnate? Some tell me it's dangerous;others that it's fine.

Answer
Hi Lynda . . .

Psychiatrists have been using the combination of one of the MAOIs and lithium for many decades. I think I treated my first patient with that combination in the mid 1960s. I have never had any difficulties with the combination and have never heard reports of problems from any of my colleagues. I is my impression that psychiatrists under the age of 45 have very little experience with MAOIs and are quite hesitant to prescribe them.

Here are a few abstracts on the topic:

1. Am J Psychiatry. 1985 May;142(5):619-23.

Efficacy of lithium-tranylcypromine treatment in refractory depression.

Price LH, Charney DS, Heninger GR.

Twelve inpatients with major depression refractory to at least two controlled
antidepressant trials had tranylcypromine added to ongoing lithium treatment.
Eleven patients showed reliable improvement in nurses' depression ratings
compared with a prior trial of lithium added to an antidepressant that was not a
monoamine oxidase inhibitor (MAOI). Eight patients were blindly judged much or
very much improved, and all 12 patients improved sufficiently to be discharged.
Preclinical studies of conjointly administered lithium and MAOIs suggest that
central serotonergic pathways may mediate this robust clinical effect.

PMID: 3920923 [PubMed - indexed for MEDLINE]


2. J Clin Psychopharmacol. 1986 Jun;6(3):165-7.

Rapid antidepressant effect of addition of lithium to tranylcypromine.

Tariot PN, Murphy DL, Sunderland T, Mueller EA, Cohen RM.

A chronically depressed patient who had not responded to treatment with several
tricyclic antidepressants and monoamine oxidase inhibitors alone, responded
within hours following the addition of lithium to ongoing tranylcypromine
treatment in a double-blind medication trial. The findings are discussed in the
context of reports of lithium augmentation of other antidepressants.

PMID: 3711366 [PubMed - indexed for MEDLINE]


3. Am J Psychiatry. 1988 Feb;145(2):249-50.

The combination of lithium carbonate and an MAOI in refractory depressions.

Fein S, Paz V, Rao N, LaGrassa J.

Department of Psychiatry, Brookdale Hospital Medical Center, Brooklyn, NY 11212.

Lithium combined with phenelzine alleviated the symptoms of four severely
depressed patients. Previously, all four patients had failed to respond to
tricyclic antidepressants, and three had not responded to monoamine oxidase
inhibitors.

PMID: 3124635 [PubMed - indexed for MEDLINE]


4. J Clin Psychopharmacol. 1994 Oct;14(5):353-6.

A prospective study of lithium augmentation in antidepressant-resistant geriatric
depression.

Flint AJ, Rifat SL.

Geriatric Psychiatry Program, Toronto Hospital, Ontario, Canada.

This open, prospective study investigated the efficacy of lithium augmentation in
elderly patients who had failed to respond to a 6-week course of antidepressant
medication. Twenty-one patients (age range, 64 to 88 years) with DSM-III-R
unipolar, nonpsychotic major depression refractory to a 6-week course of
nortriptyline, fluoxetine, or phenelzine underwent a minimum of 2 weeks of
lithium augmentation. Five patients had a complete response, 3 had a partial
response, and 13 did not respond. Half of the patients developed dose-limiting
side effects, most commonly neuromuscular or neurologic. Patients developing side
effects were significantly older (p = 0.05), and there was a tendency for side
effects to occur more frequently in patients treated with fluoxetine. The rate of
response to lithium augmentation in this elderly population was lower than that
reported for most open and controlled studies in younger patients. Possible
reasons for this are discussed.

PMID: 7806693 [PubMed - indexed for MEDLINE]

Best regards . . .

Ivan
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