An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder

Dan V. Iosifescu, Andrew A. Nierenberg, David Mischoulon, Roy H. Perlis, George I. Papakostas, Julie L. Ryan, Jonathan E. Alpert, Maurizio Fava

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objective: In an open trial, we investigated the efficacy of triiodothyronine (T 3) 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 T 3 50 μg/day. Atypical and melancholic sub-types 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 T 3 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.

Original languageEnglish (US)
Pages (from-to)1038-1042
Number of pages5
JournalJournal of Clinical Psychiatry
Volume66
Issue number8
StatePublished - Aug 2005
Externally publishedYes

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Treatment-Resistant Depressive Disorder
Major Depressive Disorder
Serotonin Uptake Inhibitors
Triiodothyronine
Depression
Diagnostic and Statistical Manual of Mental Disorders
Therapeutics
Antidepressive Agents
Interviews

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Iosifescu, D. V., Nierenberg, A. A., Mischoulon, D., Perlis, R. H., Papakostas, G. I., Ryan, J. L., ... Fava, M. (2005). An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder. Journal of Clinical Psychiatry, 66(8), 1038-1042.

An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder. / Iosifescu, Dan V.; Nierenberg, Andrew A.; Mischoulon, David; Perlis, Roy H.; Papakostas, George I.; Ryan, Julie L.; Alpert, Jonathan E.; Fava, Maurizio.

In: Journal of Clinical Psychiatry, Vol. 66, No. 8, 08.2005, p. 1038-1042.

Research output: Contribution to journalArticle

Iosifescu, DV, Nierenberg, AA, Mischoulon, D, Perlis, RH, Papakostas, GI, Ryan, JL, Alpert, JE & Fava, M 2005, 'An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder', Journal of Clinical Psychiatry, vol. 66, no. 8, pp. 1038-1042.
Iosifescu DV, Nierenberg AA, Mischoulon D, Perlis RH, Papakostas GI, Ryan JL et al. An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder. Journal of Clinical Psychiatry. 2005 Aug;66(8):1038-1042.
Iosifescu, Dan V. ; Nierenberg, Andrew A. ; Mischoulon, David ; Perlis, Roy H. ; Papakostas, George I. ; Ryan, Julie L. ; Alpert, Jonathan E. ; Fava, Maurizio. / An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder. In: Journal of Clinical Psychiatry. 2005 ; Vol. 66, No. 8. pp. 1038-1042.
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AU - Perlis, Roy H.

AU - Papakostas, George I.

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N2 - Objective: In an open trial, we investigated the efficacy of triiodothyronine (T 3) 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 T 3 50 μg/day. Atypical and melancholic sub-types 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 T 3 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.

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