Magazine article Clinical Psychiatry News

T3 Therapy Not Yet Ready for Psychiatric Use

Magazine article Clinical Psychiatry News

T3 Therapy Not Yet Ready for Psychiatric Use

Article excerpt

VANCOUVER, B.C. -- Triiodothyronine therapy is most definitely not a treatment whose time has come, a panel of experts agreed at a satellite symposium held in conjunction with the annual meeting of the American Thyroid Association.

Despite more than 3 decades of psychiatric interest in using [T.sub.3] in the treatment of depression and more recent enthusiasm for [T.sub.3] in treating primary hypothyroidism and the euthyroid sick syndrome, none of these applications is supported by reasonable clinical data--and in the case of euthyroid sick syndrome, there is a distinct potential for harm, according to the panelists.

James V. Hennessey, M.D., observed that two potential applications for [T.sub.3] in depressed patients have been pursued since the 1960s. One involves employing small doses of [T.sub.3] in an effort to accelerate onset of response to tricyclic antidepressants or selective serotonin reuptake inhibitors. The other approach uses [T.sub.3] to augment conventional antidepressant therapy to convert nonresponders to responders.

These applications are supported by several plausible hypotheses and some interesting animal studies, but the clinical trials experience to date is unconvincing, said Dr. Hennessey, an endocrinologist at Brown University in Providence, R.I.

Indeed, clinical trials provide "inconsistent and noncompelling evidence" of an antidepressant-accelerating effect for [T.sub.3], he continued. A few years ago, a meta-analysis of 30-year-old tricyclic antidepressant data concluded that [T.sub.3] does accelerate clinical response to those now seldom-prescribed agents (Am. J. Psychiatry 2001; 158:1617-22). Thus far, however, there are no confirmatory trials showing that [T.sub.3] accelerates response to SSR is and other contemporary antidepressants.

The sole randomized trial to date of [T.sub.3] augmentation of SSRI therapy in refractory depression failed to show a benefit and doesn't support the use of [T.sub.3] in euthyroid depressed patients, Dr. Hennessey said at the symposium, sponsored by Monarch Pharmaceuticals and Jones Pharma.

A 1999 study reporting superior outcomes in terms of cognition, mood, and physical symptoms in hypothyroid patients treated with a more physiologic combination of thyroxine and [T. …

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