Posted by TamaraJ on April 3, 2005, at 22:22:44
In reply to Re: My doctor can't help me, posted by Maxime on April 3, 2005, at 22:01:01
Maxime,
FYI - all from this website: http://www.modern-psychiatry.com/thyroid.htm
T4 and T3 have been shown to make anti-depressants work more quickly and to work in cases where the medication alone was not being effective. At least one study has found that a combination of both T3 and T4 worked best on mood. Actually, this is what occurs in nature and what occurs when physicians give the traditional dessicated thyroid. However, a recent small double-blind study of non-depressed hypothyroid patients did not find any benefit for using both medications.
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T-3 Helps Tricyclics Work Faster: A meta-analysis of 5 imip and 1 amitrip studies from the 70’s found not only a higher percentage of responders but also a more rapid rate of response, esp for females. Dosages ranged from 20-25 micrograms/d. AJP 01;158:1617
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Thyroid Adjunct Helps: T-3 may accelerate (Altshuler ’01) and Augment (Joffe ’93, Aronsen ’96) tricyclic action. T-4 helpful for rapid cycling (Stancer ’82, Bauer ’86). T-4 for 3-5 years at 250-500 microg/d adjunct thought helpful. One case increased lithium tremor due to T-4. Low rate of side-effects with supraphysiol dose compared to that of thyroid disorder patients. Four studies have found no bone demineralization with T-4 at supraphysiol doses. Recommens long-term only for refractory patients. Bauser ’02 Neuropsychopharm 27:620-8.
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**** Abnormal T3-RU levels are rather uncommon in outpatient depression and do not correlate with the response to antidepressant treatment or lack thereof. MGH, Int J Psychiatry Med 2001;31(4):367-73; T3 blood levels and treatment outcome in depression. Iosifescu DV, Howarth S, Alpert JE, Nierenberg AA, Worthington JJ, Fava M.; But: 65 patients in the depressed phase of bipolar I disorder who were enrolled in a larger ongoing study. A panel of thyroid measures, including thyroid-stimulating hormone (TSH), thyroxine, triiodothyronine resin uptake, and free thyroxine index (FTI), were determined before initiation of algorithm-guided treatment. The effect of each thyroid measurement on time to remission was estimated by using the Cox proportional hazards model. RESULTS: Both lower values of FTI and higher values of TSH were significantly associated with longer times to remission, i.e., slower response to treatment. Outcomes were relatively poor unless patients had FTI values above the median and TSH values below the median. Patients with this optimal profile experienced remission 4 months faster than the remainder of the study group. CONCLUSIONS: This study provides further evidence that patients with bipolar disorder are particularly sensitive to variations in thyroid function within the normal range. Our results suggest that nearly three-quarters of patients with bipolar disorder have a thyroid profile that may be suboptimal for antidepressant response. Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function. Cole DP, Thase ME, Mallinger AG, Soares JC, Luther JF, Kupfer DJ, Frank E. Am J Psychiatry 2002 Jan;159(1):116-21; UCLA, Does thyroid supplementation accelerate tricyclic antidepressant response? A review and meta-analysis of the literature. Altshuler LL, Bauer M, Frye MA, Gitlin MJ, Mintz J, Szuba MP, Leight KL, Whybrow PC.
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T3 = Lithium as TCA Adjunct: DBPC 2 weeks 50 outpatients, males and females, with unipolar, nonpsychotic major depression who had failed to respond to treatment with desipramine hydrochloride or imipramine hydrochloride. RESULTS: Both liothyronine and lithium were more effective than placebo in reducing scores on the Hamilton Rating Scale for Depression. However, the antidepressant augmenting effect of these two compounds did not differ from each other. When response was defined as a 50% or more reduction in the Hamilton Rating Scale for Depression scores and a final score less than 10, we found that 10 of 17 subjects responded to liothyronine, nine of 17 responded to lithium and three of 16 responded to placebo. Arch Gen Psychiatry 1993 May;50(5):387-93; A placebo-controlled comparison of lithium and triiodothyronine augmentation of tricyclic antidepressants in unipolar refractory depression. Joffe RT, Singer W, Levitt AJ, MacDonald C.
-----------T3 Helped TCA-T4 Non-responders in Open Trial: T3 augmentation therapy for eight depressed patients who had not responded to an adequate antidepressant drug trial and who were receiving T4 therapy for thyroid disease. T3 was prescribed in open-label fashion, and response was judged by the clinician, whose assessment was supplemented by the use of standardized rating scales. RESULTS: Seven of the nine patients were judged to respond to T3 augmentation. U Toronto, T3 augmentation of antidepressant treatment in T4-replaced thyroid patients. Cooke RG, Joffe RT, Levitt AJ. J Clin Psychiatry 1992 Jan;53(1):16-8
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T3 Helps Desipramine Rx: 38 depressed patients, we observed an increased response to antidepressant treatment with the addition of triiodothyronine but not equivalent doses of thyroxine (T4). The finding is consistent with the decreases in plasma T4 levels which accompany an antidepressant response to desipramine. U Toronto, Antidepressants and thyroid hormone levels. Joffe RT, Singer W. Acta Med Austriaca 1992;19 Suppl 1:96-7
Tamara
poster:TamaraJ
thread:477221
URL: http://www.dr-bob.org/babble/20050330/msgs/479496.html