Lithium Augmentation in Reboxetine-Refractory Depression

A substantial part of patients with major depressive episode do not respond to antidepressants. Lithium can presently be considered the best validated augmentation strategy for patients not responding to tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRI’s), venlafaxine, and mirtazapine. We present a report of successful lithium augmentation in a patient not responding to the highly selective noradrenaline reuptake inhibitor reboxetine. Whereas synergistic serotonergic mechanisms have habitually been proposed as the neurobiological basis of lithium augmentation, the presented observation raises the question of other possible rationalizations. Lithium augmentation should be considered as a treatment strategy in case of non response to specific noradrenergic antidepressants, and this strategy merits further investigations (German J Psychiatry 2005; 9: 31-32).