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THYROID HORMONES AS A THIRD LINE OF AUGMENTATION MEDICATION IN TREATMENT-RESISTANT DEPRESSION.

S Trifu1, A Popescu2, A M Dragoi2

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Summary

Thyroid dysfunction, particularly hypothyroidism, is linked to severe depression and psychotic symptoms. Supplementing antidepressants with thyroid hormones, like T3, can benefit treatment-resistant depression.

Keywords:
DIO1 geneantidepressantautoimmune pathologydepressionhypothyroidismthyroid hormones

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Area of Science:

  • Endocrinology
  • Psychiatry
  • Genetics

Background:

  • Subclinical or overt hypothyroidism significantly impacts depressive episode severity and is frequently associated with psychotic features.
  • Treatment-resistant depression in euthyroid patients may improve with thyroid hormone supplementation.
  • Thyroid dysfunction is a critical factor in understanding and managing depressive disorders.

Purpose of the Study:

  • To systematically review the relationship between hypothyroidism and depression.
  • To explore autoimmune pathology, gestational changes, and hormonal influences on depression.
  • To present effective therapeutic strategies for managing depression associated with thyroid dysfunction.

Main Methods:

  • Systematization of meta-analyses focusing on hypothyroidism and depression.
  • Analysis of autoimmune and depression comorbidity.
  • Review of gestational and puerperal pathology with hormonal and dispositional changes.
  • Presentation of integrated therapeutic schemes.

Main Results:

  • Hypothyroidism is more prevalent in major depressive episodes among women, correlating with increased hospitalizations, psychosis, treatment resistance, and somatic comorbidities.
  • Autoimmune thyroid conditions require thorough investigation due to their association with depression.
  • The DIO1 gene is a potential genetic factor in thyroid dysfunction; prenatal FT4 and TBG levels offer higher prognostic power for future depressive episodes than FT4 alone.

Conclusions:

  • Psychiatric treatment plans can integrate antidepressants and antipsychotics with enhancers, notably thyroid hormones (T3) as a third-line treatment.
  • Administered T3 doses are typically lower than daily endogenous production, minimizing the risk of clinical hyperthyroidism.
  • Thyroid hormone therapy offers a valuable adjunct in managing complex depressive disorders.