Psychopharmacology and Psychiatry Updates Lithium vs. Quetiapine: Augmenting Treatment-Resistant Depression
Jan 1, 2026
In this discussion, Dr. Paul Zarkowski, a psychiatrist and faculty contributor, dives into his comparative study on lithium versus quetiapine for treatment-resistant depression. He reveals real-world data on efficacy and side effects that spans an entire year. The conversation explores short-term remission rates and how these treatments fare against STAR*D findings. Zarkowski highlights the implications of side effects and the importance of individualized treatment choices, providing valuable insights for clinicians navigating difficult cases.
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Clinical Vignette: Rebecca The Teacher
- Dr. Richard Seeber introduces Rebecca, a 42-year-old teacher who failed two SSRIs plus bupropion and still experiences severe depression.
- This case frames the trial question of which augmentation—lithium or quetiapine—might help patients like her.
Real-World Yearlong Comparison
- A UK pragmatic open-label trial directly compared lithium and quetiapine augmentation for treatment-resistant depression over one year.
- The study targeted real-world outcomes beyond short-term remission, addressing a major evidence gap noted by STAR*D limitations.
Pre-Screening And Trial Interpretation
- Screen out bipolar and psychotic disorders before considering lithium or quetiapine augmentation.
- Use intent-to-treat analysis awareness when interpreting randomized open-label trials with nonstarters.