| Study | Population | Intervention | Comparison | Details of inadequate response/treatment resistance | Comments |
|---|---|---|---|---|---|
|
RCT Switzerland |
N=25 Mean age (years): 41.8 Gender (% female): 71 Ethnicity (% BME): NR Baseline severity: NR (more severe) | Lithium 800mg/day (target plasma levels 0.5-0.8 mmol/L) + citalopram 20-60mg/day | Placebo + citalopram 20-60mg/day | Inadequate response (improvement<50% on HAMD) to 4-week prospective treatment phase with citalopram (20-60mg/day) |
Treatment length (weeks): 1 Outcomes:
|
|
RCT Italy |
N=56 Mean age (years): 46.5 Gender (% female): 63 Ethnicity (% BME): NR Baseline severity: QIDS 18.3 (more severe) | Lithium (planned starting dose 150-300mg and target plasma levels from 0.4 to 1.0 mmol/L; actual mean dose 444 mg & mean blood level of 0.57 mEq/L) + any antidepressant | Any antidepressant | TRD: Inadequate response to ≥2 antidepressants given sequentially at an adequate dose for an adequate time for the current depressive episode |
Treatment length (weeks): 52 Outcomes:
|
|
RCT Canada |
N=33 Mean age (years): NR Gender (% female): 55 Ethnicity (% BME): NR Baseline severity: HAMD 19.47 (more severe) | Lithium 900-1200mg/day (target plasma level 0.55 nmol/L; mean dose 935.3mg/day) + desipramine/imipramine | Placebo + desipramine/imipramine | Inadequate response (HAMD score≥16) to a previous adequate trial of desipramine hydrochloride (90%) or imipramine hydrochloride (10%) ≥5 weeks |
Treatment length (weeks): 2 Outcomes:
|
|
RCT US |
N=35 Mean age (years): 38.4 Gender (% female): 46 Ethnicity (% BME): NR Baseline severity: NR (unclear severity) | Lithium (dose NR) + nortriptyline | Placebo + nortriptyline | TRD: Inadequate response to 1-5 adequate trials of antidepressants during the current episode, and failure to respond to 6 weeks of nortriptyline |
Treatment length (weeks): 6 Outcomes:
|
|
RCT UK |
N=34 Mean age (years): 47.2 Gender (% female): 79 Ethnicity (% BME): NR Baseline severity: MADRS 29.9 (more severe) | Lithium 250mg/day + TCA | Placebo + TCA | Inadequate response (failure to show improvement) to treatment with ≥3 weeks of TCA at an adequate dose |
Treatment length (weeks): 3 Outcomes:
|
BME: black and minority ethnic; HAMD: Hamilton depression scale; MADRS: Montgomery-Asberg depression rating scale; NR: not reported; QIDS: quick inventory of depressive symptomatology; RCT: randomised controlled trial; TCA: tricyclic antidepressant; TRD: treatment-resistant depression
From: Further-line treatment
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