Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function.
ABSTRACT Because treatment of the depressed phase of bipolar disorder is a clinical challenge and hypothyroidism is known to be associated with depression, the authors examined the relationship between pretreatment thyroid values and response to antidepressant treatment. It was hypothesized that subjects with lower thyroid function, even within the normal range, would have a poorer response to initial treatment.
The subjects were 65 patients in the depressed phase of bipolar I disorder who were enrolled in a larger ongoing study. A panel of thyroid measures, including thyroid-stimulating hormone (TSH), thyroxine, triiodothyronine resin uptake, and free thyroxine index (FTI), were determined before initiation of algorithm-guided treatment. The effect of each thyroid measurement on time to remission was estimated by using the Cox proportional hazards model.
Both lower values of FTI and higher values of TSH were significantly associated with longer times to remission, i.e., slower response to treatment. Outcomes were relatively poor unless patients had FTI values above the median and TSH values below the median. Patients with this optimal profile experienced remission 4 months faster than the remainder of the study group.
This study provides further evidence that patients with bipolar disorder are particularly sensitive to variations in thyroid function within the normal range. Our results suggest that nearly three-quarters of patients with bipolar disorder have a thyroid profile that may be suboptimal for antidepressant response. It remains to be seen whether pharmacological enhancement of thyroid function will facilitate recovery from bipolar depression.
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ABSTRACT: Thyroid hormone plays a role in both serotonin and catecholamine functions in the brain, and has been linked to abnormal mood states in bipolar disorder. Unlike most studies which have included only patients with bipolar I, this study evaluated triiodothyronine (T3) as an augmentation agent for treatment-resistant depression in patients with bipolar II and bipolar disorder NOS. This study was a retrospective chart review of patients treated in a private clinic between 2002 and 2006. The charts of 125 patients with bipolar II disorder and 34 patients with bipolar disorder NOS were reviewed. Patients had been unsuccessfully treated with an average of 14 other medications before starting T3. At an average dose of 90.4 mcg (range 13 mcg-188 mcg) the medication was well tolerated. None of the patients experienced a switch into hypomania, and only 16 discontinued due to side effects. Improvement was experienced by 84%, and 33% experienced full remission. The limitations are those associated with the retrospective chart review design. A high percentage of bipolar II and bipolar NOS patients with treatment resistant depression improved on T3. Despite the use of higher than usual doses in many of the patients, the medication was well tolerated. Augmentation with supraphysiologic doses of T3 should be considered in cases of treatment resistant bipolar depression.Journal of Affective Disorders 03/2009; 116(3):222-6. DOI:10.1016/j.jad.2008.12.010 · 3.71 Impact Factor
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ABSTRACT: Thyroid hormones are necessary to the brain development and their absence results into serious cognitive defects. There is some evidence that thyroid hormones activity is required in the adult brain for a correct neuronal net orchestration as well. The bonds between mood disorders and thyroid imbalances are reviewed in this paper, the molecular background of these poorly defined boundaries is exposed, along with the putative mechanisms that underlie the antidepressant effect of thyroid hormones in the event of augmentation strategy.
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ABSTRACT: Nous proposons dans cette thèse, après un bref historique des troubles bipolaires et de l'état mixte bipolaire, de vous présenter notre étude qui a fait l'objet d'un article. Cette étude rétrospective compare une population de 49 patients dépressifs purs hospitalisés à une population de 51 patients ayant présenté durant leur hospitalisation un ou plusieurs épisodes dépressifs mixtes. Les différences observées au niveau des variables socio-démographiques et cliniques contribuent à la validation d'une distinction entre dépression pure et dépression mixte. Ces résultats sont ensuite discutés en vue d'améliorer notre compréhension et notre prise en charge des patients présentant un état mixte dépressif.