August 2007

Lithium and the Risk of Alzheimer's
Lithium treatment may decrease the risk of Alzheimer's disease in patients with bipolar disorder.

T3 Augments SSRI Treatment
Adding triiodothyronine (T3) to sertraline (Zoloft and others) treatment increased response and remission rates in depressed patients.

Adding Atomoxetine to an SSRI: A Negative Study
Adding atomoxetine (Strattera) to sertraline (Zoloft and others) did not increase remission rates for depressed patients who responded incompletely to the antidepressant alone.

A Tale of Two Interactions
Quetiapine (Seroquel and others) can raise levels of r-methadone, and carbamazepine (Tegretol and others) can lower levels of aripiprazole (Abilify).

Risperidone and Prolactin in Young Patients
Prolactin levels increased in children and adolescents treated with risperidone (Risperdal) for pervasive development disorder.

In Brief
Topiramate and Cognitive Impairment in Children; Brain Structure Abnormalities in Pedophiles

More on Antidepressants and Suicide
A meta-analysis of studies of children and adolescents with depression, obsessive compulsive disorder, or anxiety disorders found a small increased risk of suicidal ideation/suicide attempt, but no completed suicides.

T3 Augments SSRI Treatment

August 2007

For many years, researchers and practitioners have employed triiodothyronine (T3) to augment antidepressant drugs. We recently reported data from the STAR*D study (BTP 2007;30:27-28), which found that patients who had failed two antidepressant trials had a rate of remission of 24.7% with T3 augmentation (up to 50 µg/day) versus 15.9% with lithium.1 In addition, T3 was better tolerated than lithium.

Most work with T3 augmentation has focused on its use in treatment-resistant depression. Now a group in Israel and the United States has compared T3 augmentation of a selective serotonin reuptake inhibitor (SSRI) with the SSRI alone in nonresistant depression.2

Cooper-Kazaz et al enrolled 124 outpatients with nonpsychotic major depressive disorder in a double-blind trial. All subjects took sertraline (Zoloft and others), 50 mg/day for a week, and then 100 mg/day. In addition, patients were assigned at random to receive either placebo or T3, 20 to 25 µg/day for a week and then 40 to 50 µg/day for the remainder of this 8-week study.

Patients receiving adjunctive T3 benefited significantly more in both response and remission rates: 70% vs 50% (P = .02) and 58% vs 38% (P = .02), respectively. There were no significant differences in adverse effects. For patients receiving the adjunct, lower baseline T3 levels predicted a better clinical response to T3. Further, greater reductions in thyrotropin during treatment were associated with better improvement during T3 treatment.

This positive study is interesting. As the authors observe, future research should focus on thyroid indices in depressed patients and how they might be used to select patients for T3 augmentation of antidepressants.

1Nierenberg AA, Fava M, Trivedi MH, Wisniewski SR, Thase ME, McGrath PJ, Alpert JE, Warden D, Luther JF, Niederehe G, Lebowitz B, Shores-Wilson K, Rush AJ, STAR*D Study Team: A comparison of lithium and T3 augmentation following two failed medication treatments for depression: A STAR*D report. Am J Psychiatry 2006;163:1519-1530.

2Cooper-Kazaz R, Apter JT, Cohen R, Karagichev L, Muhammed-Moussa S, Grupper D, Drori T, Newman ME, Sackeim HA, Glaser B, Lerer B: Combined treatment with sertraline and liothyronine in major depression: A randomized double-blind, placebo-controlled trial. Arch Gen Psychiatry 2007;64:679-688.