Lithium augmentation compared with phenelzine in treatment-resistant depression in the elderly: An open, randomized, controlled trial

Background: Up to a third of elderly patients with major depressive disorder do not respond to a first course of treatment with an antidepressant. There is a lack of controlled studies evaluating therapies for treatment-resistant depression in latelife depression, and no randomized controlled studies assessing the efficacy and tolerability of lithium augmentation in elderly patients have been published. Method: Twenty-nine elderly inpatients with major depressive disorder according to DSM-IV criteria who had previously failed to respond to 1 or more adequate trials with a tricyclic antidepressant or venlafaxine were included in a 6-week, open, randomized, controlled study with a 2-year follow-up. Subjects received either lithium augmentation or the monoamine oxidase inhibitor phenelzine. The primary outcome criterion was remission, defined as a final score of less than or equal to 10 on the Montgomery-Asberg Depression Rating Scale (MADRS). Response was defined as at least 50% reduction on the MADRS or the Hamilton Rating Scale for Depression (HAM-D). Results: Twenty-eight subjects completed the trial. Remission on the MADRS was achieved by 33.3% of the lithium patients, compared with none of the phenelzine patients (p = .042). Response also showed a difference in favor of lithium augmentation (p = .035 on both the MADRS and the HAM-D). Overall tolerability was good, with no dropouts due to side effects. Subjective memory impairment was more prevalent among patients receiving phenelzine (p = .002), and tremors were significantly more prevalent among patients receiving lithium (p = .002). During the 2-year follow-up, 25 patients (86.2%) did achieve remission, particularly on prolonging the lithium treatment (5 patients) or on lithium augmentation to phenelzine (5 patients). Conclusion: Lithium was more effective than phenelzine in elderly patients with treatment-resistant major depressive disorder, while tolerance of both treatments was remarkably good in this group of elderly inpatients with many comorbid medical disorders

Regulatory Fit at Work: Gravitational Effects and Associations with Employee Well-being

Using a task approach, this study examined the extent to which employee regulatory focus would “gravitate” employees towards promotion- versus prevention-oriented tasks within their jobs, and whether a subsequent regulatory fit/misfit would be associated with their well-being (i.e., mental health and job satisfaction). In a pre-study among 37 employees, we determined the regulatory focus of work tasks from the Netherlands Skill Survey, which are relevant to the general working population, resulting in a selection of 7 promotion and 11 prevention tasks. For our main study, we used the Dutch Longitudinal Internet Studies for the Social Sciences (LISS) panel and collected data from 1,606 respondents. In 2011, we collected respondents’ regulatory focus and in 2012, we collected their work tasks and well-being. Promotion-oriented employees considered both promotion and prevention tasks to be highly relevant in their jobs, and this relevance was associated with their mental health. Prevention-oriented employees, however, did not respond to the relevance of promotion or prevention tasks and generally reported lower well-being, irrespective of the regulatory focus of their tasks. We tentatively conclude that promotion focus gravitates employees towards job with a richer task content, containing both promotion and prevention tasks