Thyroid drug enhances antidepressant response in major depression

A multi-center research team have shown that the addition of the thyroid hormone liothyronine (Cytomel®) improved the response to the SSRI antidepressant sertraline (Zoloft®) in patients with major depressive disorder. While there is a significant body of medical opinion in favor of adding a thyroid hormone to standard antidepressive drug treatment in patients with major depression, especially those who have not responded to the antidepressive drug alone, this mode of therapy is still controversial. The trial evidence to support it mostly relates to tricyclic antidepressives and the evidence for augmenting with SSRI is limited. Rena Cooper-Kazaz, MD, and colleagues aimed to determine whether liothyronine improved response to sertraline when used as initial therapy in adult patients with major depression. Eligible patients had a diagnosis of major depression, with scores of 16 or greater on the 21-item Hamilton Rating Scale for Depression (HRSD) and no previous history of thyroid disease. They were randomized to treatment with sertraline plus liothyronine (20 or 25 microgram daily for one week, then 40 or 50 microgram daily thereafter) or placebo. Patients' thyroid status was determined at baseline to find out whether this influenced results. Treatment duration was eight weeks and the primary outcome measure was response to treatment, defined as a 50% or greater reduction in HRSD from baseline. A total of 197 patients was screened, of whom 124 were eligible and randomized to the study; 103 completed at least one week of treatment and were included in the final analysis (77 completed the full course). Response rate was significantly greater in the liothyronine group compared to the placebo group with 70% vs. 50% achieving a response as defined (p =0.02; odds ratio, 2.93; 95% CI, 1.23-7.35); those in the liothyronine group also had greater remission rates (58% vs. 38%). Responders in the liothyronine group had lower baseline T3 values than non-responders. There was no significant difference between the groups in adverse effects or withdrawal rates. The authors conclude that according to their results, liothyronine significantly enhances the effect of SSRI in major depression, increasing both response and remission rates by about 20%. Patients who responded had indications of lower thyroid function at baseline. While they do not consider that the study would support the combination as routine, they suggest that it may be beneficial for appropriate patients. Further work is advisable to allow the results to be generalized to a wider range of patients and other SSRIs. Cooper-Kazaz R, Apter JT, Revital Cohen R, Karagichev L, et al. Combined Treatment With Sertraline and Liothyronine in Major Depression Arch Gen Psychiatry. 2007;64:679-688.   [Abstract] (Source: Latest entries from www.anxietyinsights.info)