Following his Psych Congress 2019 presentation on drug combinations in major depressive disorder, Michael Thase, MD, discussed when clinicians should consider using thyroid hormone as an antidepressant augmentation strategy and possible risks of the approach.
Dr. Thase is Professor of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Read the transcript:
Adding a thyroid hormone to an ineffective or incompletely effective antidepressant's been something that psychiatrists have done since the 1960s, 1970s. It's one of the better studied and better proven strategies.
I think it makes the most sense when the patient has a history of partly treated or undertreated thyroid disease, and you actually have evidence that one or another of their thyroid hormones is suboptimal—for example, since we screen with TSH, an elevated TSH level.
If the patient's already on thyroid hormone, I would want to consult with their prescribing doctor, their endocrinologist, or their primary care provider. Maybe they'll want to simply increase the thyroid hormone they're taking already. Sometimes we add T3 to T4 as a way of enhancing function, also.
There are some risks with this strategy. Some people will get sweaty palms, rapid pulse. If the patient has a history of heart disease, again, you should do this in collaboration with their primary care provider. During long‑term treatment, if you over‑suppress the thyroid, you are adding to the risk of osteoporosis.
If you've done it and it works, you'll want to do a handoff at some point with the patient's primary care doc to make sure this is followed carefully on a longitudinal basis.