TREATMENT OF INTRACTABLE NON-RAPID CYCLING BIPOLAR AFFECTIVE-DISORDERWITH HIGH-DOSE THYROXINE - AN OPEN CLINICAL-TRIAL

Six patients with very severe forms of non-rapid cycling bipolar affec tive illness whose symptoms had previously been refractory to all curr ent antidepressant and/or prophylactic medications were treated with s upraphysiological doses of thyroxine (250 to 500 mu g/day) as art adju vant to their previous medications. The mean follow-up period was 27.8 +/- 12.8 months (range 12 to 46). The mean number of relapses during the follow-up period of each patient declined from 5.3 +/- 3.1 to 0.8 +/- 0.8 and the mean duration of hospitalization from 10.0 +/- 5.6 to 0.8 +/- 1.2 months as compared to the same length of time for each pat ient before the start of treatment with high-dose thyroxine (T4). Thre e of the patients had no further relapses at all. Thus, for these pati ents, who had previously been severely ill and therapy-resistant, high -dose T4 administration proved to have excellent effects on the course of the illness. However, in five of these patients the effect of the T4 was strong enough only when it was administered in combination with a prophylactic and antidepressant and/or neuroleptic drug, of which i n some cases high doses were also needed. The side effects were neglig ible. Mechanisms that may possibly underlie the beneficial effects of high-dose T4 in bipolar affective disorder are discussed.