Lithium Augmentation in Major Depressive Disorder

Monitoring and Maintenance

Clinicians should assess patient status, therapeutic response, and adverse effects of therapy regularly, beginning within 1-2 weeks of initiation, as recommended by the American College of Physicians, based on evidence from the Annals of Internal Medicine 1 and other sources 2
The American Academy of Pediatrics suggests that at every assessment, clinicians should evaluate ongoing depressive symptoms, risk of suicide, possible adverse effects from treatment, adherence to treatment, and new or ongoing environmental stressors 3
Regular laboratory monitoring is essential when using lithium due to its narrow therapeutic window, according to guidelines from the National Institute of Health, as published in PLoS Medicine 4

For patients with a first episode of major depressive disorder, treatment should continue for 4-9 months after symptom resolution, as recommended by the American College of Physicians, based on evidence from the Annals of Internal Medicine 1
For patients with 2 or more previous depressive episodes, longer duration therapy (potentially years) may be beneficial due to higher risk of recurrence, according to the American Psychiatric Association, based on evidence from the Annals of Internal Medicine 1 and other sources 2
The risk of relapse is highest during the first 2-3 months after discontinuation of treatment, requiring close follow-up during this period, as suggested by the American Academy of Pediatrics 3 and other sources 2