Hypothyroidism and depression: salient aspects of pathogenesis and management

Hypothyroidism and depression: salient aspects of pathogenesis and management

This paper makes me ask: How many anti-depressants are you expected to try (and many of them are acknowledged to make things worse to begin with, and require weeks to ramp up and then tail off) before you might, if very lucky, get the chance to try liothyronine (T3)?

(And given current GP/endo attitudes, how long will anyone continue to get the liothyronine, no matter how effective it is?)

Minerva Endocrinol. 2013 Dec;38(4):365-77.

Hypothyroidism and depression: salient aspects of pathogenesis and management.

Duntas LH, Maillis A.


Endocrine Unit, Evgenidion Hospital, University of Athens, Athens, Greece - ledunt@otenet.gr.


Hypothyroidism has been linked to depression as there is irrefutable evidence that it triggers affective disease and psychic disorders. Depressive patients have a higher frequency of hypothyroidism and patients with hypothyroidism have a higher occurrence of depressive syndrome. Hypothyroidism exhibits considerable alterations in blood flow and glucose metabolism in the brain. Furthermore, patients with major depression may have structural abnormalities of the hippocampus that can affect memory performance. Thyroid peroxidase antibodies have, moreover, been positively associated with trait markers of depression. Depressive symptomatology is variable and is influenced by susceptibility and the degree, though not always, of thyroid failure. In addition, glucose homeostasis and rapid weight loss have been associated to thyroid hormones and increased depressive symptoms. Thyroxine treatment in patients older than 65 years does not improve cognition. In contrast, T3 administration is the therapy of choice in patients with resistance to antidepressive drugs, and especially to SSIR. Genetic variants of thyroid hormone transporters or of deiodinases I and II may predispose to depression and, therefore, a personalized approach should be implemented.

PMID: 24285104 [PubMed - in process]



Image is of a 50mcg Cytomel tablet

5 Replies

  • thanks for this it gives me a little hope.

    A LIITTLE as I have been subjected to so many already from every category including duloxetine which I'm sure nearly killed me as I have an albeit undiscosed liver condition (but my medical records blood tests say different) as duloxetine is contra indicated for liver conditions. My GP even said to me "oh I see you didn't like the duloxetine" despite her advertising she has a special interest in psychiatry!!! I was literally ill and my bladder was compromised also.

    In my last appt with the Psychiatrist he again asked what anti depressants I had been on ?? I mentioned a few and he said oh I will check your records. (end of subject)

    I received my assessment notes and I was speechless as he has stated ---------- has agreed to dicuss anti depressant medication in the next appointment. I did NOT

    I am intollerant to all categories but they have no idea why?? but I am 1000% sure it is T3 and adrenal but they are obviously refusing to consider this at all. I even took documents in desperation but he said he doesn't have time to read them and only non thyroid patients are trialled on T3.

  • Post to your consultant the above Research Paper. It is an up-to-date one as well.

  • Rod, that's an excellent link. It also another Paper which will be disregarded completely by most of the Endocrinology Departments worldwide.

  • I have already and he refused.

    They know exactly what they are doing and secondary care are under orders from the almighty GP's themselves who think they are now GOD and act like they are because they hold the POWER and the budgets and have to achieve their incentive targets set down by the CCG's

  • pulsetoday.co.uk/clinical/t...

    We have no chance for T3 when they are being advised not to "overdiagnose" thyroid cancer as it is too costly.

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