Combining triiodothyronine with an antidepressant
drug results in more rapid improvement in patients with depression
(March 2002)
The background of
the study. In some studies, patients with depression improved
more rapidly when treated with a tricyclic antidepressant drug therapy
and triiodothyronine (T3) as compared with a tricyclic antidepressant
drug alone. This study was an analysis of all studies in which the
two treatments were evaluated.
How the study was done. The criteria
for identification of studies for the analysis were that the study
was a double-blind, placebo-controlled trial in which patients with
depression were treated with T3 or placebo within five days after
the start of antidepressant drug therapy, and that a standardized
scale was used to assess the severity of depression. Six studies
that met these criteria were identified. The number of patients
ranged from 15 to 30. The dose of T3 was 20 to 25 µg daily
in five studies and 25 to 62.5 µg daily in one study. The antidepressant
drug was imipramine in five studies and amitriptyline in one. Efficacy
was determined after 21 to 28 days of treatment using the Hamilton
rating scale for depression in all studies.
The results of the study. In five
of the six studies the combination of an antidepressant drug and
T3 resulted in a statistically significantly more rapid improvement
as compared with antidepressant drug and placebo. For example, in
one study the score on the rating scale fell by 50 percent after
11 days of treatment in the antidepressant drug and T3 group but
only after 22 days of treatment in antidepressant drug and placebo
group. In most studies the fall in score was similar in the two
groups by the end of the study period. The analysis revealed the
accelerated effect of combination therapy to be statistically significant
(P<0.002).
The conclusions of the study. In
patients with depression, administration of a low dose of T3 speeds
the response to therapy with a tricyclic antidepressant drug.
The original article. Altshuler
LL, Bauer M, Frye M, Gitlin MJ, Mintz J, Szuba MP, Leight KL, Whybrow
PC. Does thyroid supplementation accelerate tricyclic antidepressant
response? A review and meta-analysis of the literature. Am J Psychiatry
2001;158:1617-22.
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