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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by SLS on September 13, 2005, at 7:26:59
Hi.
I came across an article describing the use of T3 (triiodothyronine) thyroid hormone in combination with SSRI for treatment resistant depression. It seems that T3 will improve unipolar atypical depression, but make unipolar melancholic depression worse. Cytomel T3 made me much worse. However, my depression is bipolar. On the other hand T4 (thyroxine) helped me.
Perhaps the selection of which thyroid hormone to choose for augmentation of antidepressants should be determined by the subtype of depression being treated; T4 for melancholic unipolar and bipolar depression and T3 for atypical unipolar depression. One thing I would recommend based upon my own experience with thyroid hormones is that one cannot rule-out the usefulness of one type based upon the response to the other.
- Scott
1: J Clin Psychiatry. 2005 Aug;66(8):1038-42. Related Articles, Links
An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder.Iosifescu DV, Nierenberg AA, Mischoulon D, Perlis RH, Papakostas GI, Ryan JL, Alpert JE, Fava M.
From the Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston.
OBJECTIVE: In an open trial, we investigated the efficacy of triiodothyronine (T(3)) adjuvant to selective serotonin reuptake inhibitors (SSRIs) in subjects with major depressive disorder (MDD) resistant to SSRI treatment. METHOD: Twenty subjects who met DSM-IV criteria for MDD (mean +/- SD age = 44.3 +/- 10.3 years; 55% [N = 11] women) and had failed to respond to a course of treatment of at least 8 weeks with an SSRI antidepressant were enrolled in a 4-week open-label augmentation treatment with T(3) 50 mug/day. Atypical and melancholic sub-types of MDD were diagnosed using Structured Clinical Interview for DSM-IV Axis I Disorders criteria. We administered the 17-item Hamilton Rating Scale for Depression (HAM-D-17) 4 times during the study (which was conducted between 2001 and 2003). RESULTS: During T(3) augmentation, the severity of depression decreased from an initial mean +/- SD HAM-D-17 score of 20.5 +/- 3.6 to a final HAM-D-17 score of 14.0 +/- 7.1 (p < .001). Seven subjects (35.0%) were treatment responders (HAM-D-17 reduction >/= 50%), and 6 subjects (30.0%) achieved clinical remission (final HAM-D-17 </= 7). The 5 subjects with atypical depression experienced significantly (p < .01) greater clinical improvement (final HAM-D-17 scores 6.6 +/- 1.8 vs. 16.4 +/- 4.5), and higher rates of treatment response (100% [5/5] vs. 13.3% [2/15]) and remission (80.0% [4/5] vs. 13.3% [2/15]), compared to subjects with nonatypical MDD. The 8 subjects with melancholic MDD experienced significantly (p < .05) greater depression severity at the end of the study compared to nonmelancholic MDD subjects (final HAM-D-17 scores = 18.3 +/- 6.6 vs. 11.1 +/- 6.1). CONCLUSION: Triiodothyronine augmentation of SSRIs may be a promising treatment strategy in SSRI-resistant MDD, particularly in subjects with the atypical MDD subtype.
PMID: 16086620 [PubMed - in process]
Posted by gromit on September 13, 2005, at 9:03:06
In reply to Thyroid hormone augmentation of SSRI - differences, posted by SLS on September 13, 2005, at 7:26:59
> Perhaps the selection of which thyroid hormone to choose for augmentation of antidepressants should be determined by the subtype of depression being treated; T4 for melancholic unipolar and bipolar depression and T3 for atypical unipolar depression. One thing I would recommend based upon my own experience with thyroid hormones is that one cannot rule-out the usefulness of one type based upon the response to the other.
I'm really interested to hear what folks have to say about this. The tests always say my thyroid is fine but I have many symptoms that seem to match up with being hypothyroid. I had a doctor turn me down when I asked to be pushed a little higher. My last doc seemed obsessed with the whole thing but couldn't remember to get the reports from the lab.
Rick
Posted by SJW on September 13, 2005, at 12:59:24
In reply to Thyroid hormone augmentation of SSRI - differences, posted by SLS on September 13, 2005, at 7:26:59
Hi Scott,
Speaking of the thyroid are you familiar with the work of Dr. Broda Barnes and/or Dr. Wilson (Wilson's syndrome). Among other things they have come to the conclusion that the basal tempature test is the most accurate way to determine thyroid status.
Good Luck,
Steve
Posted by Phillipa on September 13, 2005, at 20:55:11
In reply to Re: Thyroid hormone augmentation of SSRI - differe » SLS, posted by SJW on September 13, 2005, at 12:59:24
Scott, I believe the thyroid plays a bigger part in depression than anyone would have you believe. When working as a nurse in psych I was amazed at the number of pts on thyroid supplementation. I even had a pdoc who believed cytomel could help with depression. I my self have hashimotos thyroiditis and after I was diasnosed I was never the same. First flu like feelings and tightness in my chest. I couldn't expand my lungs to breath or cough. Spent 2 days on the couch sleeping. Then my anxiety went off the charts and my TSH was sky high. I was started on synthroid and told I might need highter or lower doses of xanax but I was able to back to work and after a week or so I felt much better and downed the xanax dose. Then I woke up one night with vertigo and had to go to ER for IM 2mg of ativan. After that I never was the same. And I really think my thryroid caused all of my problems. Fondly, Phillipa
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