THYROXINE AUGMENTATION OF FLUOXETINE TREATMENT FOR RESISTANT DEPRESSION IN THE ELDERLY - AN OPEN TRIAL

Drug resistant depression is a confounding entity. More so in populati ons of elderly depressives where addition of lithium or antidepressant combinations are possibly hazardous. We present an open-trial of thyr oxine in elderly patients diagnosed as suffering from resistant depres sion. Methods - Thyroxine 50 mcg/day was added to fluoxetine 20 mg/day in patients who did not respond to previous, non-SSRI, antidepressant treatment (6 weeks), nor to an additional 6 weeks of fluoxetine. Subj ects - Subjects were diagnosed as suffering from major depression, acc ording to DSM-III-R criteria. All had normal thyroid function tests (T SH and FT4). There were 15 patients in our series: nine females, six m ales; mean age 72.1 years (+/-6.5). Results - Patients depression seve rity was graded using the Hamilton Depression Rating Scale at baseline (before thyroxine augmentation), and 4 weeks after initiation of trea tment. Ten of 15 patients responded to thyroxine augmentation (HDRS < 10), 3/15 showed no improvement of HDRS scores and two dropped out due to adverse effects: diarrhoea and tachycardia. Conclusions - Thyroxin e augmentation of fluoxetine is effective in elderly subjects resistan t to standard treatment, and is relatively safe.