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Original Research

Triiodothyronine Augmentation of Selective Serotonin Reuptake Inhibitors in Posttraumatic Stress Disorder

Ofer Agid, Arieh Y. Shalev, and Bernard Lerer

Published: March 1, 2001

Article Abstract

Background: There is considerable comorbidity ofmajor depression and posttraumatic stress disorder (PTSD), andantidepressants have been reported to be effective in treatingPTSD. Addition of triiodothyronine (T3) to ongoingantidepressant treatment is considered an effective augmentationstrategy in refractory depression. We report the effect of T3augmentation of antidepressants in patients with PTSD.

Method: T3 (25 microg/day) was addedto treatment with a selective serotonin reuptake inhibitor (SSRI)(paroxetine or fluoxetine, 20 mg/day for at least 4 weeks and 40mg/day for a further 4 weeks) of 5 patients who fulfilled DSM-IVcriteria for PTSD but not for major depressive disorder (althoughall patients had significant depressive symptoms). TheClinician-Administered PTSD Scale, the 21-item Hamilton RatingScale for Depression, and the Clinical GlobalImpressions-Severity of Illness scale were administered every 2weeks, and self-assessments were performed with a 100 mm visualanalog mood scale.

Results: In 4 of the 5 patients, partialclinical improvement was observed with SSRI treatment at a dailydose of 20 mg with little further improvement when the dose wasraised to 40 mg/day. This improvement was substantially enhancedby the addition of T3. Improvement was most strikingon the Hamilton Rating Scale for Depression.

Conclusion: T3 augmentation of SSRItreatment may be of therapeutic benefit in patients with PTSD,particularly those with depressive symptoms. Larger samples andcontrolled studies are needed in order to confirm thisobservation.

Volume: 62

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