Thyroid Augmentation Helps Depression (And Bipolar Disorder in Women)

January 4, 2011 · Posted in Current Treatments 

Low dose thyroid replacement treatment with T3 (Cytomel) (25-37.5 µg) is typically recommended for acute antidepressant augmentation in unipolar and bipolar depression. This approach has few side effects and works even in those with normal thyroid function at baseline.

Thyroid Augmentation

Some data also supports the use of relatively high (supraphysiological) doses of T4 (Synthroid) late in the treatment of highly treatment-resistant patients with unipolar and bipolar disorder.  These supra-physiological doses of T4 typically ranged from 300-500 µg/day, producing a free thyroxine index of 150% of normal. This is usually moderately well tolerated, although minor degrees of sweating, tachycardia (fast heartbeat), and other signs of hyperthyroidism can accompany this regimen. If this approach is employed, it is particularly important to increase the dose of T4 (Synthroid) very slowly because of its relatively long half-life—about 12 days. (That is, if a patient takes a high dose of T4 and then stops their medication completely, 12 days later blood levels will only have decreased to half of what they originally were.)

Findings about high-dose T4 for women with treatment-resistant bipolar illness after the jump.

At the 4th Biennial Conference of the International Society for Bipolar Disorders in Sao Paulo, Brazil in March, Mike Bauer presented new data from a randomized placebo-controlled study of supraphysiologic T4 in bipolar patients.  In this study, he increased the dose by 100 µg/week toward a target dose of 300 µg/day.  There was no overall statistical significance of this high dose thyroid regimen compared with placebo in the group as a whole, but the results were highly statistically significant in women treated with this strategy. Earlier studies of low dose T3 augmentation also suggested that women were more responsive to thyroid augmentation strategies than men.

Thus, in the face of inadequate treatment responses to complex combination strategies, it appears that, for the first time, there are double-blind, placebo-controlled data supporting the use of supraphysiological doses of thyroid in women whereas, heretofore, the only evidence of efficacy of this approach existed in small case series studied across institutions in the U.S. and Europe.


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