Levothyroxine "augmentation" for depression.
|Article Type:||Brief article|
|Subject:||Depression, Mental (Drug therapy)|
|Author:||Gaby, Alan R.|
|Publication:||Name: Townsend Letter Publisher: The Townsend Letter Group Audience: General; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2008 The Townsend Letter Group ISSN: 1940-5464|
|Issue:||Date: June, 2008 Source Issue: 299|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
Seventeen euthyroid women (aged 30-60 years) with depression that
had failed to respond to serotonergic antidepressants (tricyclic or
selective serotonin-reuptake inhibitors) received 100 mcg/day of
levothyroxine for four weeks while continuing their previous medication.
After four weeks, 11 women (65%) were in remission, defined as a score
of 7 or less on the Hamilton Depression Rating Scale (HDRS). Five other
patients showed a decrease of more than 50% on the HDRS. Thus, 94% of
the patients showed improvement or resolution of symptoms. The efficacy
of levothyroxine augmentation did not correlate with pretreatment
laboratory tests results for thyroid function (T3, T4, TSH, and TRH
stimulation test), all of which were normal.
Comment: Previous studies have shown that the addition of triiodothyronine (T3) to standard therapy is often effective for depressed patients who have failed to respond to antidepressant drugs alone. The present study suggests that a moderate dose of levothyroxine (T4) is also effective when used as adjunctive therapy. In most of these studies, the investigators assumed that thyroid hormone somehow caused the antidepressants to work better. An alternative explanation is that some of the successfully treated patients were clinically hypothyroid and that they would have improved with thyroid hormone alone, without the use of antidepressants. Although the patients in the present study were euthyroid according to standard laboratory tests, it is my belief that these tests fail to identify a large proportion of patients who are clinically hypothyroid (see Gaby AR. "Sub-laboratory" hypothyroidism and the empirical use of Armour thyroid. Altern Med Rev. 2004;9:157-179.)
Lojko D, Rybakowski JK. L-thyroxine augmentation of serotonergic antidepressants in female patients with refractory depression. J Affect Disord. 2007; 103:253-256.
by Alan R. Gaby, MD
|Gale Copyright:||Copyright 2008 Gale, Cengage Learning. All rights reserved.|