T3 augmentation of SSRI resistant depression.
Level 4 - case-series / case-control
Uncontrolled, open-label single-arm clinical trial (case series)
PubMed 16483669 · doi:10.1016/j.jad.2006.01.013
What was done
Twelve euthyroid adults (8 females, 4 males, age 26–77) with non-psychotic DSM-IV major depression who had failed at least six weeks of SSRI treatment (baseline 17-item HAMD >= 18, normal TSH, normal TRH-ST) were enrolled. Patients continued their existing SSRI (sertraline, citalopram, fluvoxamine, or paroxetine) and received add-on triiodothyronine (T3) starting at 25 mcg/day, increased to 50 mcg/day within a week if tolerated, for at least three weeks.
What was found
One patient withdrew in the first week due to side effects, leaving 11 completers. Mean daily T3 doses were 40.6 mcg for women (mean duration 3.75 weeks) and 43.8 mcg for men (mean duration 3.5 weeks). T3 augmentation was associated with a statistically significant reduction in mean HAMD scores at three weeks versus baseline (p < .003). Five patients (42%) achieved >= 50% improvement on HAMD scores, and three patients (25%) achieved full remission (HAMD <= 7). Responders and non-responders did not differ reliably by baseline HAMD, prior antidepressant trials, gender, or Deltamax TSH.
Why it matters
This study provides preliminary open-label evidence that T3 augmentation may be a tolerable and inexpensive option for major depressive disorder failing standard SSRI monotherapy.
Limits
The sample size was very small (n = 12), there was no control group or blinding, treatment duration was short (3 to 4 weeks), and long-term efficacy and safety were not assessed.
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- contradicts The DSM-IV states that if antidepressants do not work, clinicians should consider Cytomel (T3).