Towards Personalized Lithium Therapy
Research into a biomarker combination that predicts response to lithium in severe depression
Approximately one third of all patients with severe depression do not respond to therapy despite adequate multimodal treatment. In these cases, the administration of lithium can increase the effectiveness of antidepressants. Around 40 percent of patients benefit from this. In order to know who will respond to lithium supplementation before starting treatment, we want to investigate the predictive factors for response to lithium in more detail.
For many decades, lithium has been a proven medication for the treatment of severe depressive and bipolar disorders. Experts assume that lithium influences neurotransmitter activity and the interaction of various brain regions that are altered by the disorder. Lithium can work well, but different people react differently to the medication. Experts do not yet know why this is the case.
The aim of the DECIDE study is to identify factors with which we can predict the individual response to lithium treatment in treatment-resistant depression. To do this, we are dependent on the help of our patients: Our study is aimed at inpatients, day-patients and outpatients with treatment-resistant depression, for whom treatment with lithium is planned.
Inclusion criteria and study process
Patients are eligible for the DECIDE study if they are currently suffering from a major depressive episode, have not responded to at least one attempt at treatment with an antidepressant during the current depressive episode and for whom treatment with lithium is planned.
Unfortunately, we cannot include the following patients in the study:
- Age: < 18 years
- Contraindications for lithium: severe cardiovascular disease, severe renal dysfunction and sodium balance disorders
- History of hypomanic or manic episodes
- Competing pharmacological augmentation strategy
- Simultaneous use of two or more antidepressants, with the exception of the combination with sleep-promoting antidepressants such as mirtazapine, mianserin or trazodone
- Patients with a relevant comorbidity of the central nervous system, such as focal neurological diseases (stroke, tumor), current or previous epilepsy, CNS inflammation including autoimmune diseases
- Electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS) in the current depressive episode
Before administering lithium and during the first weeks of treatment with lithium, we carry out various examinations as part of the study in order to precisely record the patient's condition:
- Symptom assessment using psychological questionnaires
- Clinical interviews
- Magnetic resonance imaging
- Psychophysiology
- Laboratory diagnostics (we take blood samples for this purpose)
Patients being treated with lithium are closely monitored with regard to their symptoms and the potential side effects of lithium. After approximately 3-6 weeks, we evaluate whether the lithium supplementation has improved the symptoms, and optional final examinations are carried out.
If the patients give their consent, we will contact them again approximately one year after starting lithium treatment, to inquire about the course of their illness after the treatment.
Are you interested in supporting our research by participating in the DECIDE study? Then please contact your treating physician.
