[Liothyronine augmentation in depression].

Abstract

Background: The revised Dutch Multidisciplinary Guideline for Depression recommends liothyronine (T3) augmentation to selective serotonin reuptake inhibitors (SSRIs) as one of several third-line treatment options for moderate to severe depression, the others being lithium and atypical antipsychotics. The guideline refers to two network meta-analyses demonstrating efficacy.

Aim: To evaluate the evidence for efficacy of T3 augmentation to SSRIs in depression.

Method: A PubMed and Cochrane Central search was conducted for controlled trials investigating T3 added to an SSRI.

Results: Seven studies were identified, three assessing augmentation and four examining co-initiation. Among the augmentation studies, only one was placebo-controlled and found no significant T3 effect. Of the two active-controlled trials, one open-label study suggested better efficacy than lithium, while the other did not specify whether T3 or T4 was used (dose suggested T4) and showed similar efficacy to other augmentation options. The co-initiation trials reported conflicting results, ranging from better outcomes with T3 to no difference or trend toward worse outcomes.

Conclusion: The efficacy of T3 augmentation to an SSRI is not yet sufficiently established. Network meta-analyses are based primarily on active-controlled studies. Given the potential role of T3, a long-term, placebo-controlled trial is needed to clarify the effectiveness of T3 augmentation to an SSRI.