Michael Thase, MD on Considering Lithium as a Treatment for Depression

Michael Thase, MD, weighs in on when lithium should be considered as a depression treatment and when it should it be avoided.

Dr. Thase is Professor of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.

Additional Resources:

 Addressing Ineffective Antidepressant Treatment 


Lithium, like thyroid hormone, is one of the original augmentation strategies that began to be studied in the 1960s, 1970s. It's also well‑proven, although most of the evidence comes from studies done when the tricyclic antidepressants were number one. There may be less evidence with the SSRIs.

Maybe tolerability is not quite as good with lithium added to a SSRI or SNRI, but I still think there's a role for this medicine. The most recent reviews have placed it on a level that is comparable, or nearly comparable, in benefit with a great advantage in cost and reasonable safety, compared to the newer generation antipsychotic medications.

I would pick it first when there is a family history of lithium response, a family history of bipolar disorder, a personal history that might suggest the patient's illness falls within the bipolar spectrum, or when the patient has a classic recurrent pattern of depression, rapid onset, sometimes abrupt offsets, that might suggest the illness falls within the bipolar spectrum.

Don't get me wrong. This isn't just indicated for people who have subtle bipolar disorder. It can enhance the effects of antidepressant even in patients who don't have that history.

Obviously, lithium can be neurotoxic. It can be toxic to the kidneys, nephrotoxic. In patients with frail health who have a history of heart disease and so forth, you'll want to do this thoughtfully and carefully and make sure that the primary care doc is on board with the practice.


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