Refractory depression: treatment strategies,
with particular reference to the thyroid axis

by
Joffe RT
Department of Psychiatry,
McMaster University, Hamilton, Ont.
J Psychiatry Neurosci 1997 Nov; 22(5):327-31


ABSTRACT

In the last few years, it has become evident that major depressive disorder often runs a chronic and recurrent course. Early effective intervention may increase the liklihood of a good long-term prognosis. The main treatment options for patients who fail to respond to antidepressant therapy and the relative advantages of each are critically reviewed. These include substitution, replacing one antidepressant with another, and augmentation/combination, in which a second antidepressant is added to the first. Particular emphasis is placed on the role of triiodothyronine (T3) in augmentation therapy. The theoretic rationale for using augmentation/combination therapy and its relative advantages and disadvantages over substitution therapy are critically reviewed.
T3
T3 v T4
Selenium
Anhedonia
Melancholy
T3 + SSRIs
Venlafaxine
Dopaminergics
Bipolar disorder
Thyroid hormones
Augmentation strategies
Thyroxine (T4): structure
Triiodothyronine (T3): structure
The thyroid axis and depression
Triiodothyronine (T3) and major depression
High-dosage thyroxine as an antidepressant
Thyroid hormone, mood modulation and the brain
Mechanisms of thyroid augmentation of antidepressants

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