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The authors conducted an open-label study of the efficacy and tolerability of venlafaxine and of lithium augmentation in outpatients with depression who were not responding to venlafaxine. Outpatients aged 18 to 70 years were eligible if they had a minimum baseline score of 16 on the 17-item Hamilton Rating Scale for Depression (HAM-D). Patients were started on venlafaxine 37.5 mg twice daily for 1 week. For weeks 2 through 4, the dose of venlafaxine was increased to 75 mg twice daily, and for weeks 5 through 7, the dose was further increased to 75 mg three times daily. At the end of the 7-week treatment period, patients with a <50% decrease in their HAM-D scores from baseline were given lithium carbonate 600 mg once daily. The dose of lithium carbonate was adjusted to maintain plasma levels in the range of 0.6 to 1.0 mmol/mL. Efficacy was assessed with the 17-item HAM-D, Montgomery-Åsberg Depression Rating Scale, and the Clinical Global Impressions Scale. Data were analyzed on an intent-to-treat basis. At the end of the 7-week treatment period, 35% of patients showed a ≥50% decrease in their HAM-D scores from baseline. Lithium augmentation was initiated in 23 patients. The results showed that the addition of lithium was well-tolerated and led to a further decrease in the HAM-D scores, with eight patients responding and two of them presenting a remission. The addition of lithium to venlafaxine was found to be a well-tolerated strategy in treatment-resistant patients.

The effects of a daily program of various activities on disturbed behavior were studied prospectively in three patients with severe dementia. Prior to the study, patients had not responded to treatment with benzodiazepines and/or neuroleptics. The study consisted of three periods, each lasting for 4 weeks: i.e., baseline, intervention, and follow-up. During each period, behavior was assessed by means of observation scales: GIP, SDAS, and CGI. Psychotropic medication was held as constant as possible. During intervention, the patients took part in a program of activities, including group, musical, physical, and social activities. During baseline and follow-up, patients followed the regular ward activities. The patients showed different responses, probably related to personal interests. Possible implications for the treatment of patients with dementia, complicated by disturbed behavior, and suggestions for future research are discussed. The enthusiasm of the nursing staff dealing with these patients was a promising result.