DOES THYROID-HORMONE HAVE A ROLE AS ADJUNCTIVE THERAPY IN DEPRESSION

Depression is associated with abnormalities of the thyroid axis, but t he role of thyroid hormone therapy is controversial. In patients prese nting with depression, the thyroid status should be carefully evaluate d since hypothyroidism can cause depression. Frank hypothyroidism shou ld be treated in the usual fashion with L-thyroxine, which may reverse the depressive state. If subclinical hypothyroidism and/or autoimmune thyroiditis are present, T-3 adjuvant administration (25 mu g/day) sh ould be seriously considered in patients resistant to tricyclic antide pressant (TCA) (and probably also) serotonin selective reuptake inhibi tor (SSRI) medication. The possible efficacy of adjuvant T-4 in revers ing the depression of such subjects appears less than T-3. In depresse d patients with TCA or SSRI resistance and no evidence of hypothyroidi sm, the data available do not establish the therapeutic role of T-3 in this situation. Multicenter controlled studies of T-3 adjuvant therap y are required. The possible mechanisms through which T-3 adjuvant the rapy might be efficacious are discussed.