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Combining triiodothyronine with an antidepressant drug results in more rapid improvement in patients with depression
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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