Cytomel augmentation in affective d/o

[Solideliquid]

Has anyone used cytomel (liothyronine) as an augmenting agent with an anti-depressant or mood stabilizer in their patients with MDD or Bipolar d/o?

I've done a search on pubmed and it seems that there are a few studies (recently cited in the Feb 09 issue of Current Psychiatry, Cooper-Kazaz http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)
and it seems there is some evidence that non-responders can benefit from this augmentation.

I've picked up a few patients in my clinic with cytomel and it seems in some of them their TSH is down to very low levels and I'm not sure if I should be concerned about this. I've discussed it with an endocrinology fellow and he didn't like that I was using cytomel. He pointed out that it's cardiovascular side effects were too risky.

Thoughts?

Edit: Also, any thoughts about using levothyroxine instead any advantage/disadvantages?

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[kugel]

thyroid supplementation is one of the classic augmentation strategies, not the first choice on most lists, but certainly known for decades.

cytomel and synthroid both known and used. Some always use cytomel, some synthroid. don't know of really good solid evidence for using one vs the other.

When using a thyroid supplement in a euthyroid pt, of course the TSH will be low.

 

[billypilgrim37]

Didn't STAR*D stage 3 or 4 use cytomel as one of its interventions?

 

[IAmAUser]

.

 

[Solideliquid]

So do some of you use cytomel? Do you prefer T4?

 

[worriedwell]

I'm pretty sure that the data when scrutinized supports cytomel as preferable to synthroid as an augmentation strategy in mood disorders. In fact, I think synthroid is negligible in terms of efficacy in mood disorders. It appears that they are NOT interchangable

worriedwell

 

[antonis]

T3
for the treatment of refractory depression.
References
1. Joffe rt. Psychiatry res 1990,32,241-51
2. Anderson im. Adv psychiatr treat 2003, 9,11-20
3. Iosifescu dv. J clin psychiatry 2005,66,1038-42
4. Abraham g. j affect disord 2006, 91,211-15
5. Nieremberg aa. STAR D

 

[michaelrack]

I'm pretty sure that the data when scrutinized supports cytomel as preferable to synthroid as an augmentation strategy in mood disorders. In fact, I think synthroid is negligible in terms of efficacy in mood disorders. It appears that they are NOT interchangable

worriedwell

Agree with this in general, though wasn't there 1 paper about using supraphysiological doses of synthroid in rapid cycling bipolar d/o??

 

[worriedwell]

Agree with this in general, though wasn't there 1 paper about using supraphysiological doses of synthroid in rapid cycling bipolar d/o??

Not sure...never saw that. I think the Joffe paper was the one real head to head about synthroid vs. cytomel and moving forward, they just didn't use synthroid much in the good studies so maybe its just a lack of data, but at this point if using for depression augmentation, I'd go with cytomel.

However, if a patient is clinically hypothyroid with comorbid depression, then I think synthroid is the endrocrinologist choice to correct the thyroid axis which may then improve the mood symptoms if indeed the diagnosis is mood d/o secondary to medical condition. So that then confuses this a bit I guess. Plus most people don't order thyroid antibodies routinely to check for low grade hypothyroid syndromes (if those are even relevant to mood d/o that is) so it remains a bit confusing how important the thyroid is in mood disorders.

Then one also gets into the bipolar spectrum where things like lithium exposure might alter the thyroid axis (does that lead to rapid cycling?) and then maybe synthroid is the choice to stabilize the thyroid axis which then might help with augmentation to avoid rapid cycling.

Complicated but interesting stuff that I don't think is yet well understood.