An Open Study of Triiodothyronine Augmentation of Selective Serotonin Reuptake Inhibitors in Treatment-Resistant Major Depressive Disorder
Dan V. Iosifescu, MD; Andrew A. Nierenberg, MD; David Mischoulon, MD; Roy H. Perlis, MD; George I. Papakostas, MD; Julie L. Ryan, BA; Jonathan E. Alpert, MD; and Maurizio Fava, MD
Objective: In an open trial, we investigated the
efficacy of triiodothyronine (T3) adjuvant to
selective serotonin reuptake inhibitors (SSRIs) in subjects with
major depressive disorder (MDD) resistant to SSRI treatment.
Method: Twenty subjects who met DSM-IV criteria
for MDD (mean ± SD age = 44.3 ± 10.3 years; 55% [N = 11] women) and had
failed to respond to a course of treatment of at least 8 weeks
with an SSRI antidepressant were enrolled in a 4-week open-label
augmentation treatment with T3 50 mg/day. Atypical and
melancholic subtypes of MDD were diagnosed using Structured
Clinical Interview for DSM-IV Axis I Disorders criteria. We
administered the 17-item Hamilton Rating Scale for Depression
(HAM-D-17) 4 times during the study (which was conducted between
2001 and 2003).
Results: During T3 augmentation, the
severity of depression decreased from an initial mean ± SD
HAM-D-17 score of 20.5 ± 3.6 to a final HAM-D-17 score of
14.0 ± 7.1 (p < .001). Seven subjects (35.0%) were treatment
responders (HAM-D-17 reduction >= 50%), and 6 subjects (30.0%)
achieved clinical remission (final HAM-D-17 <= 7). The 5
subjects with atypical depression experienced significantly
(p < .01) greater clinical improvement (final HAM-D-17 scores
6.6 ± 1.8 vs. 16.4 ± 4.5), and higher rates of treatment response
(100% [5/5] vs. 13.3% [2/15]) and remission (80.0% [4/5] vs.
13.3% [2/15]), compared to subjects with nonatypical MDD. The 8
subjects with melancholic MDD experienced significantly
(p < .05) greater depression severity at the end of the study
compared to nonmelancholic MDD subjects (final HAM-D-17
scores = 18.3 ± 6.6 vs. 11.1 ± 6.1).
Conclusion: Triiodothyronine augmentation of
SSRIs may be a promising treatment strategy in SSRI-resistant
MDD, particularly in subjects with the atypical MDD subtype.
J Clin Psychiatry 2005;66(8):1038-1042
© Copyright 2005 Physicians Postgraduate Press, Inc.