L-Thyroxine augmentation of serotonergic antidepressants in female patients with refractory depression

Department of Adult Psychiatry, Poznan University of Medical Sciences, ul.Szpitalna 27/33, 60-572 Poznan, Poland.
Journal of Affective Disorders (Impact Factor: 3.38). 12/2007; 103(1-3):253-6. DOI: 10.1016/j.jad.2007.01.016
Source: PubMed


Triiodothyronine (T3) augmentation in treatment-resistant depression had been successfully performed with both tricyclic as well as with SSRI antidepressants. In this paper, the efficacy of addition of moderate dose of l-thyroxine (T4) to serotonergic antidepressants in refractory depression was evaluated.
The study included 17 female patients, aged 30-60 years, with treatment-resistant depressive episode in the course of unipolar or bipolar mood disorder. All patients had no history of thyroid axis disturbances and had T3, T4, and thyroid-stimulating hormone (TSH) values within the normal range. The antidepressants preceding thyroxine augmentation were serotonergic antidepressants (clomipramine - 11 patients, paroxetine - 5 patients, fluoxetine - 1 patient). l-thyroxine was added in the dose of 100 microm daily for 4 weeks.
After four weeks of l-thyroxine augmentation, the remission, assessed as 7 or less points on Hamilton Depression Rating Scale (HDRS) was obtained in eleven patients (64.7%). Five other patients (29.5%) had responded (reduction>50% on HDRS) and one patient did not show an improvement. The efficacy of augmentation did not show any correlation with laboratory tests' results performed before (T3, T4, TSH and TSH stimulation test) as well as with any clinical factors (age, diagnosis, duration of illness, duration of episode).
The addition of moderate dose of l-thyroxine may be a successful augmentation strategy in female depressed patients in whom the effect of serotonergic antidepressant had been unsatisfactory. It may be efficient despite of the lack of disturbances of thyroid axis in such patients.

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    • "Two of the more recent studies have attempted thyroid hormone augmentation of patients with refractory bipolar depression using slightly different strategies. Łojko et al.[126] found addition of moderate doses of T4 (100 mcg/day) to be a successful augmentation strategy in female patients with bipolar depression, who had had an unsatisfactory response to serotonergic antidepressants. Another retrospective chart review of 125 patients with treatment-resistant bipolar depression showed augmentation with high dose T3 to be highly effective, though there were some concerns about adverse effects of this treatment [127]. "
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