Lithium and quetiapine augmentation therapy in treatment-resistant depression with atypical features.
Gianmarco Ingrosso, Stefano Masier, Armando D'Agostino et al.
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In 30 seconds
This secondary analysis of the randomised LQD trial assessed whether atypical features influenced outcomes with lithium or quetiapine augmentation in treatment-resistant depression. Among 212 participants, 32 (15.1%) had atypical features. Depressive symptoms improved with both treatments over 52 weeks, with QIDS-SR scores decreasing by an average of 0.09 points per week (p < 0.001). After adjustment for atypicality, the analysis found no significant difference between treatments and no evidence that atypical features moderated response. The authors describe the findings as exploratory.
Key findings
- Of 212 participants, 32 (15.1%) presented with atypical features.
- QIDS-SR scores decreased by an average of 0.09 points per week (p < 0.001) over the 52-week follow-up.
- Atypical features did not significantly moderate response to either augmentation treatment in completer or modified intention-to-treat analyses.
- No significant difference between lithium and quetiapine emerged after adjustment for atypicality.
Why it matters
Atypical features, including increased sleep and appetite, may raise concern that augmentation side effects could hinder improvement. In this analysis, these features did not appear to preclude symptom improvement with either treatment. The results offer relevant but preliminary evidence about treatment response across depressive presentations.
What to keep in mind
The atypical subgroup was small, and the authors note modest predictive performance in some models; the findings are exploratory.