Study designs of evaluations included in the review
Double-blind, placebo-controlled randomised controlled trials (RCTs) were eligible for inclusion.
Specific interventions included in the review
Studies in which patients were treated with any antidepressant plus lithium in any dose or with placebo were eligible for inclusion. The patients in the included acceleration studies were treated with clomipramine, maprotiline, tianeptine, amitriptyline, desipramine, or various tricyclic antidepressants. The doses of lithium given in addition to these antidepressants were 750 to 900 mg each day or a serum level of 0.7 to 1.3 mmol/L. The duration of treatment ranged from 3 to 6 weeks. The patients in the included augmentation studies were treated with citalopram, nortriptyline, various antidepressants, or various tricyclic antidepressants alone or in conjunction with tetracyclics, monoamine oxidase inhibitors or selective serotonin re-uptake inhibitors. Where stated, the duration of treatment ranged from 2 to 42 days.
Participants included in the review
Patients with unipolar or bipolar disorder, depressive phase, were eligible for inclusion. For inclusion in the acceleration meta-analysis, studies had to include only patients that had not previously had appropriate treatment for the depressive episode. For inclusion in the augmentation meta-analysis, studies had to include only patients unresponsive to conventional antidepressants. The participants in the included studies were male and female, mean age 37 to 54 years (where stated), with unipolar and bipolar disorder.
Outcomes assessed in the review
Studies that used an accepted criterion for depressive episodes and reported outcomes in a clear, dichotomous classification and/or with a valid depression scale were eligible for inclusion. The primary outcome for the acceleration meta-analysis was the change in depression scale rating at 1 to 2 weeks after treatment. The primary outcome for the augmentation meta-analysis was the odds ratio (OR) of patients responding. Included lithium acceleration studies assessed depression using the Hamilton Rating Scale for Depression (HAM-D) and the Montgomery-Asberg Depression Rating Scale at days 7, 11 and 14. Included lithium augmentation studies assessed the change in HAM-D score and change in Short Clinical Rating Scale.
How were decisions on the relevance of primary studies made?
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.