Augmentation Treatment for Depression: Liothyronine (T3)

Augmentation Treatment for Depression:

Liothyronine (T3)


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)

  1. + Aripiprazole, Brexpiprazole, Cariprazine = increases risk of hyperglycemia = monitor glucose. 
  2. + Carbamazepine = decrease Liothyronine efficacy. 
  3. + 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?

    1. Obtain baseline TSH, free T3 and free T4 prior to augmentation.
    2. Recheck these labs at 3 month and then 6 monthly. Goal is TSH in normal range (around 0.4 uIU/ml).
    3. In postmenopausal women: bone density needs monitoring Q2 yearly. Refer for evaluation of osteoporosis if bone density is declining.
    4. 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)

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