Difficult To Treat Depression A Carlat Guide – Chris Aiken

Most patients prefer the controlled release version, of which there are two available. Lithium CR (Eskalith) peaks at a lower level than lithium ER (Lithobid), which in theory translates to better tolerability. In practice, the choice usually depends on the dose, as lithium CR comes in size 450 mg and ER as 300 and 600 mg.

For some patients, lithium has little acute benefit but profound preventative effects. This presents a challenge, as patients are better at appreciating acute effects than preventative ones. Comparing their mood chart before and after lithium can give them a more meaningful sense of its benefits. Lithium is a collaborative effort. It requires thoughtful management on the part of both the patient and provider. Assure your patients that you are committed to making lithium successful and tolerable. When managed well, the extra effort strengthens the therapeutic alliance.

TABLE 19-1. Lithium Levels Level Children and Adults Geriatrics (≥65) Treats Low 0.1–0.5 0.1–0.3 Unclear; low levels may augment other mood stabilizers, and might prevent dementia, suicide, and the progression of bipolar disorder Medium 0.6–0.8 0.4–0.7 Depression (as monotherapy in bipolar depression, or as antidepressant augmentation in unipolar); this is also a good maintenance level to prevent episodes of mania or depression High 0.8–1.2 0.6–0.9 Active mania Toxic >1.2 Varies Only causes harm Monitoring Check labs every 3–6 months on lithium.

More frequent checks are needed when patients are starting lithium, psychiatrically unstable, or have risk factors for lithium toxicity, like older age, drug interactions, or declining renal function. Check the lithium level along with basic chemistries, calcium, and thyroid stimulating hormone (TSH). TABLE 19-2.

Published by Carlat Publishing, LLC PO Box 626, Newburyport, MA 01950 Publisher and Editor-in-Chief: Daniel J. Carlat, MD Deputy Editor: Talia Puzantian, PharmD, BCPP Senior Editor: Ilana Fogelson All rights reserved. This book is protected by copyright. This CME/CE activity is intended for psychiatrists, psychiatric nurses, psychologists, and other health care professionals with an interest in mental health. The Carlat CME Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Carlat CME Institute maintains responsibility for this program and its content.

Carlat CME Institute designates this enduring material educational activity for a maximum of twelve [12] AMA PRA Category 1 CreditsTM. Physicians or psychologists should claim credit commensurate only with the extent of their participation in the activity. The American Board of Psychiatry and Neurology has reviewed the Difficult to Treat Depression and has approved this program as part of a comprehensive Self-Assessment and CME Program, which is mandated by ABMS as a necessary component of maintenance of certification. CME tests must be taken online at www.thecarlatreport.com/cme (for ABPN SA course subscribers).

To order, visit www.thecarlatreport.com or call (866) 348-9279 Print: 979-8-9998818-1-6 eBook: 979-8-9893264-6-4 PRINTED IN THE UNITED STATES OF AMERICA OceanofPDF.com To Kellie Newsome Special thanks to Daniel Carlat, Owen Muir, and Michael Sikorav for reviewing the manuscript Illustrations by Eleanor Aiken OceanofPDF.com Table of Contents Section I: Introduction Chapter 1: What is “Difficult-to-Treat” Depression?

This is a short excerpt from the opening of “” by Unknown, quoted for review and introduction purposes. All rights belong to the copyright holders.

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