Augmentation Treatment for Depression:
Which one is preferred for depression augmentation treatment: T3 or T4?
- T3 is preferred over T4 for depression augmentation.
- Augmentation of antidepressants with T3 is one of the oldest evidence based treatment.
How to initiate and titrate Cytomel (Liothyronine) as augmentation for depression management?
- Initiate 12.5 mcg and increase to 25 mcg Q1-2 weeks.
Liothyronine 25 mcg = Levothyroxine 100 mcg = Thyroid (porcine) 60-65 mg = 1 grain of desiccated thyroid or thyroglobulin.
Cautions and Contraindications for Cytomel (Liothyronine) treatment:
- Patient with underlying cardiovascular system disorders, particularly the coronary arteries: patients with angina pectoris or the elderly.
- Diabetes mellitus, Diabetes insipidus
- In these patients initiate Cytomel at low dose of 5 mcg daily, and should be increased by no more than 5 mcg increments at 2-week intervals.
- Diagnosed but as yet uncorrected adrenal cortical insufficiency.
- Untreated thyrotoxicosis.
- Hypersensitivity to any of their active or extraneous constituents.
Important Drug Interactions with Cytomel (Liothyronine)
- + Aripiprazole, Brexpiprazole, Cariprazine = increases risk of hyperglycemia = monitor glucose.
- + Carbamazepine = decrease Liothyronine efficacy.
- + Digoxin = decrease digoxin levels.
What is the duration for augmentation with T3 in resistant depression?
- Clinical improvement in depression is noted within 1-3 days of initiation of T3.
- Significant improvement in depression is noted after 3 weeks.
What are the recommended safety guidelines for T3 augmentation of antidepressants?
- Obtain baseline TSH, free T3 and free T4 prior to augmentation.
- Recheck these labs at 3 month and then 6 monthly. Goal is TSH in normal range (around 0.4 uIU/ml).
- In postmenopausal women: bone density needs monitoring Q2 yearly. Refer for evaluation of osteoporosis if bone density is declining.
- Continue re-evaluation periodically the risk & benefits of T3 supplementation.
- J Clin Psychopharmacol. 1989 Feb;9(1):73.
- Am J Psychiatry 168:10, Oct 2011.
- Liothyronine package insert.
Please do post your questions or comments below.
Dr. Harvinder Singh, M.D. (Admin)
Enroll in our online course to have access to all important clinically relevant psychiatry topics in one place.