Thyroid Augmentation May Improve Depression in Women with Treatment-Resistant Bipolar Depression
We have previously written about a study of supra-physiological doses of levothyroxine (a synthetic version of the hormone T4 sold under the brand name Synthroid) performed by Mike Bauer and colleagues in Dresden, Germany and at UCLA. Sixty-three patients were initially treated with an antidepressant and/or a mood stabilizer for one week during a single-blind phase. Then the six-week double-blind phase of the study began, in which patients were given either adjunctive T4 (in the form of levothyroxine ) or placebo, and this was followed by an additional six weeks of open treatment with T4. Patients were started at 100mcg and increased on a weekly basis to 200 and then 300mcg/day.
Overall, T4 had no statistically significant effect that differentiated it from placebo, but among women, there was a significantly greater degree of improvement in the Hamilton Rating Scale for Depression scores for those on T4 (-42.4%) than for those on placebo (-16.6%), p= .018.
Editor’s note: This study is the first randomized, placebo-controlled trial of supra-physiological doses of T4. A small series of reports in the literature from several different investigative groups had previously suggested efficacy of this compound in rapid cycling and treatment-resistant patients. Read more
Moclobemide May Help Depression and Post-Partum Blues
Monoamine oxidase inhibitors (MAO-Is) are a type of antidepressant that is often effective for people with anxious depression or comorbid panic attacks, especially when other antidepressants don’t work. This may be because MAO-Is work on all three neurotransmitter systems implicated in depression: dopamine, norepinephrine, and serotonin.
In a recent study presented at the 65th Annual Scientific Convention of the Society of Biological Psychiatry, Julia Sacher et al. found that six weeks of therapeutic doses of the MAO-I moclobemide (at doses of 300 mg twice a day) significantly decreased monoamine oxidase A, as measured by PET scans in brain regions implicated in mood disorders. In a comparison of moclobemide, placebo, and the herbal preparation St. John’s Wort, only moclobemide had a significant effect. Read more
rTMS for Adolescent Depression
In an abstract presented at the 65th Annual Scientific Convention of the Society of Biological Psychiatry, Christopher Wall reported that treatment with rTMS (10 Hz at 120% of motor threshold) was successful in the treatment of adolescent depression.
These data from an open (as opposed to blind) study deserve further and more systematic investigation. Alternatives to antidepressant drug treatment are desirable for adolescents with depression since increases in suicidal ideation are a potential side effect during the first two months after initiation of pharmacological antidepressant treatment in teens. (Suicidal ideation and actions among adolescents decrease with longer-term antidepressant treatment, especially when it is used in conjunction with cognitive/behavioral psychotherapy.) Children and adolescents treated with antidepressants may also be at higher risk for switching into mania than adults treated with antidepressants.
Editor’s Note: The rTMS parameters used in this study are the same as those used successfully in adults with depression in the two large positive multi-center sham-controlled studies (one by industry and one by the National Institute of Mental Health) mentioned in yesterday’s article.
Anti-Alzheimers’s Drug Memantine (Namenda) May Augment the Antidepressant Effects of Lamotrigine
At the 65th Annual Scientific Convention of the Society of Biological Psychiatry in May, Amit Anand reported that the anti-Alzheimer’s drug memantine (20 mg/day) was superior to placebo in augmenting the acute antidepressant effects of lamotrigine. These data are of particular interest since one of the assumed mechanisms of action of lamotrigine is to decrease the release of glutamate.
Memantine is a drug approved for the treatment of Alzheimer’s disease and is a partial antagonist (blocker) of glutamate NMDA receptors. This suggests that the dual actions of inhibiting glutamate’s release pre-synaptically (with lamotrigine) and blocking glutamate receptor activity post-synaptically (with memantine) combine to produce a better effect than that of lamotrigine alone.
5 Myths About Unipolar Depression
Early this year, news stories such as Newsweek’s “The Depressing News About Antidepressants” and “Antidepressant Drug Effects and Depression Severity” in the Journal of the American Medical Association (JAMA) created an inadequate picture of the seriousness of clinical depression, and the importance of preventing recurrent episodes with long-term antidepressant treatment. (For a rebuttal, see Psychiatric Times.)
The consequences of this distorted depiction of depression and its treatment are potentially dire for individuals’ health. Some of the popular myths about depression deserve critical review so that patients can make more informed decisions about their own treatment.
Myth 1: Depression is all in your mind
Myth 2: Depression is over-treated
Myth 3: Antidepressant efficacy barely exceeds that of placebo
Myth 4: Antidepressants should be stopped as soon as possible
Myth 5: Depression is a minor medical problem
Myth 1: Depression is all in your mind
This might seem valid, since depression is classified as a mental illness. But depression is not abstract, imaginary, or lacking a solid physical foundation. There is now overwhelming evidence that depression coincides with disturbances in multiple brain and body systems.
