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T3 augmentation of SSRI resistant depression
Gebrehiwot Abraham1, Roumen Milev, J Stuart Lawson
1Department of Psychiatry, University of Toronto, ON, Canada. gaby_Abraham@camh.net
Journal of Affective Disorders
|February 18, 2006
Summary
Adding triiodothyronine (T3) to standard SSRI treatment significantly improved mood scores in patients with major depressive disorder resistant to initial treatment. This safe and inexpensive augmentation strategy showed a 42% response rate, suggesting T3 remains a viable option for treatment-resistant depression.
Area of Science:
- Endocrinology
- Neuroscience
- Psychiatry
Background:
- Major depressive disorder (MDD) is a leading cause of disability worldwide.
- Selective serotonin reuptake inhibitors (SSRIs) are first-line treatments for MDD.
- A significant proportion of patients with MDD exhibit inadequate response to SSRI monotherapy, necessitating augmentation strategies.
Purpose of the Study:
- To evaluate the efficacy of triiodothyronine (T3) as an augmentation therapy for patients with non-hypothyroid major depressive disorder (MDD) who have not responded to standard SSRI treatment.
- To assess the safety and tolerability of T3 augmentation in this patient population.
Main Methods:
- A cohort of patients meeting DSM-IV criteria for MDD, with a Hamilton Depression (HAMD) score ≥18 and normal thyroid function tests, were recruited.
- Participants continued their existing SSRI treatment and were augmented with 25-50 mcg/day of T3 for at least three weeks.
- Thyroid-stimulating hormone (TSH) and thyrotropin-releasing hormone stimulation test (TRH-ST) were within normal ranges for all participants.
Main Results:
- T3 augmentation led to a statistically significant reduction in HAMD scores (p < .003) compared to baseline.
- Forty-two percent (5 out of 12) of patients achieved ≥50% improvement in HAMD scores, with three patients reaching full remission (HAMD ≤7).
- The augmentation was generally well-tolerated, with only one patient withdrawing due to side effects.
Conclusions:
- Triiodothyronine (T3) augmentation is an effective and safe strategy for improving mood in patients with treatment-resistant major depressive disorder.
- The observed response rate of 42% is comparable to other augmentation strategies, supporting the continued use of T3.
- T3 represents a viable, inexpensive, and effective treatment option that should not be prematurely replaced by newer, potentially less cost-effective strategies.