I read about this study in today's Washington Post. I have written to the author asking her about trying to see if treating low T3 would have an effect on the ability to discontinue antidepressant medication.
Why not T3 for depression?: I read about this... - Thyroid UK
A very sensible thought - thanks for asking. Please do let us know if you get a response.
I always thought my severe depression was related to my hypo. Despite taking only T3 for many years, I still had bad mental health. It wasn't until I started taking Methylated multi B vitamins did my mental health improve. It was like a switch being turned. I'm certain I have the mutated MTHFR gene, probably from both parents.
I think it is starting to be used. I have seen several papers now. This is one.
There are others. Some dating back a decade or so.
I'm curious, why would people want to take T3 rather than anti-depressants? As someone who has to take T3 I'd much rather take just one anti-depressant tablet a day than fiddle about with T3. As a vegan, supposed to graze all day since we don't take in slow release proteins, I find fitting in 3 doses of T3 with a 2 hour gap between food or drink and 4 hours away from my iron tablet and a time space between T3 and magnesium etc for my bones manageable at home but really difficult when away with friends or family.
Hi thyr0ld having been on antidepressants in the past and now on t3/t4 combo have to say I would rather take t3 over antidepressants even thou it can be a faff, antidepressants really don't work very well especially if your need is t3, have to say I only felt half alive on antidepressants.
Have you experimented with taking t3 and not worrying about the food aspect?I find it makes no difference if I take the t3 with or away from food. I don’t think the instructions for the hormone specifically say avoid food as they do for levo.
Thank-you beh1, this is such a helpful comment because I have never thought of experimenting with not avoiding eating around T3. I'm a bit nervous because without T3 I'm at coma level, but I'm going to try.
I don't do it. It was making me angry trying to leave all the gaps. I like to graze. I leave 3/4hr before taking T3 if I can and 1/2hr after it. I have done the 2 hour thing. Didn't notice a difference between the two. If I end up taking a little more T3 to compensate, fine. I'll do that.
This is really helpful to hear that you also don't go without food/drink for 2 hours around T3. Do you someties take more T3 to compensate ?
No. I don't vary my dose. I am still working my dose upwards, slowly. I found that by releasing myself from the torture of trying to allow 2 hours either side, and setting lower standards for myself, the pressure is off and I don't think about it. Thus often leaving longer gaps than the clock watching mode I was in before.
Some people religiously leave their food and drink off for 2 hours before and 1 or 2 hours afterwards. Others take their dose with food! We have to do what works for us. I can't stand the strain of it, I have enough other strains going on. And I'm wasting far fewer cups of tea!
Hallo again FancyPants and thanks, you made me smile because I've just decided not to waste a cup of coffee! Having just finished teaching Yoga I am about to begin counselling a client. It's time for T3 but the choice is take it now, when I'm very cold after being in a cold hall, or having a nice hot cup of coffee and leave the T3. After counselling it will be too close to lunchtime for a dose so second dose is going to be when 3rd should be and 3rd will have to be abandoned. All for a cup of coffee!
I'd have taken the T3 and had the coffee. Mind you I drink decaf. Whilst it has some caffeine in it, it's not as much as full force coffee. Well you aren't doing too badly if you can teach a yoga class. I haven't been able to exercise for years. I miss it so much. I was the first person in the UK to open a class for hula hoop dance! And now look at me. A couch potato the size of a whale. One day, I will finally get my T3 level to a decent point and then hopefully I will be able to function again.
There are several possible ways of looking at this. I'll suggest one:
If someone is suffering from depression which is caused by inadequate T3, then taking anti-depressants seems to be a case of addressing a symptom when it would likely be better to go straight to the cause.
It is not as if anti-depressants don't have any side effects.
There is also the nearly impossible mountain to climb - finding the right dose of an appropriate anti-depressant for the individual. The NHS super-simple advice speaks of taking for four weeks. Then, quite likely, increasing dose. And taking several weeks or longer to come off them.
The British National Formulary lists about 29 medicines in its list of anti-depressants. Not suggesting everyone will need to try all of them, but getting from nothing to a reasonably effective and tolerable choice could be a long path. Possibly finding little positive benefit alongside side effects - repeatedly.
We see discussion of treatment-resistant depression which does not resolve despite treatment. Which indicates that they have tried at least a few anti-depressants. And that anti-depressants do not work for all.
It might be that inadequate T3 is a fundamental factor in some depression. One that ensures other treatments cannot work. It might appear to investigators that T3 augments an anti-depressant which is not how I see it if there simply isn't enough T3. Maybe some will require T3 and anti-depressants?
Anti-depressant isn't a hormone. T3 is and it is the 'active thyroid hormone'. Our brain and heart have the most T3 receptor cells and cells are all over our bodies.
This is an excerpt from the link below:-
The thyroid hormone receptors (TRs) are members of the nuclear receptor superfamily that exhibit a dual role as activators or repressors of gene transcription in response to thyroid hormone (T3) and provide a model system for investigating complex networks of cellular trafficking and gene expression.
Some people have forms of depression which are AD resistant. The addition of T3 to the right AD can make an enormous difference to the efficacy of the AD
Hi MorecambeBay, this is very interesting. Is it a theory, or patients experiences (eg clinical audit) or have there been controlled and peer-reviewed trials which demonstrate it as a fact? Is it patients whose T3 is low to whom T3 makes a difference or is there no correlation?
I’m not a doctor. This is a peer to peer support group. We learn from each other and from trusted sources.
Many sources on this subject. I’m pasting just a few below
There are very many other sources which discuss the use of T3 in conjunction with an AD to augment the AD in the case of treatment resistant depression. There are others which outline cases of use of T3 without an AD where T3 is optimal and patient is euthroid and of course cases where T3 is used where T3 is optimal where exogenous hormones are used.
It seems obvious to me that a doctor should test thyroid when a depressed patient presents. That said, the few that do would probably never test FT3.
Thanks for the articles. Interesting that in the first of those doses of over 75 mcg Liothyronine are associated with increased morbidity (bone loss related). The second is not a trial but a case study of one woman who was already on Levothyroxine and therefore very likely to need T3 for the thyroid problem which was presumably the cause of her depression, the third article doesn't seem to mention T3. I think people have been extrapolating in a way one cannot reliably do with case studies. Having looked at your original article I cannot see any reference to T3, did I miss it?
There are trials as well as case studies on the internet. Will look for a couple but there are many there.
Can you point me in the direction of my original article? Not sure which one you mean.
Before I researched this myself I was being treated by a Consultant Psychiatrist and it was she who explained a great deal to me about this subject.
That makes sense, you'll see from my last post we were screening for thyroid problems when patients were referred with depression back in the late 70s. Even then we used to be angry when it turned out the poor patient had not been tested and in fact was hypothyroid and didn't need psychiatric care.
"Is it a theory, or patients experiences (eg clinical audit) or have there been controlled and peer-reviewed trials which demonstrate it as a fact? Is it patients whose T3 is low to whom T3 makes a difference or is there no correlation?"
"Have I missed something? Is the suggest of T3 for depression only for those diagnosed as hypothyroid?"
The use of T3 for treatment resistant depression is well known. in this context there des not need to be a thyroid disease diagnosis (or low fT3 levels) before it is prescribed.
The NHS use T3 for "Treatment RESISTANT/REFRACTOTRY depression" , (note, T3 it is not used by NHS for depression that does respond to Anti Depressants, but is occasionally used for depression that has not responded to various AD's.. and as such, psychiatrists are allowed to prescribe it for this purpose even in the absence of any diagnosed thyroid disease dysfunction.
Eg. the following guidelines from Sussex NHS;
"3. Treatment of refractory depression (1)
3.1 Combination of antidepressant medication with CBT should be considered if not already
3.2 Common treatment options are listed below:
Tri-iodothyronine(T3) ... 20-50 micrograms per day .....40 micrograms / £393 .... TFT monitoring required."
If anyone is looking for further information on the historical use of T3 in this context, it is necessary to search for "treatment RESISTANT/REFRACTORY depression " not "depression" or "anxiety/ depression"
Thank-you tattybogle, this is interesting as is that little word diagnosed in this part: "in the absence of any diagnosed thyroid problem". I wonder if they rule out thyroid problems or just don't bother testing.
Mmm... i wonder .. that would probably be option B) then ... not bother testing ?
Or perhaps option C) ' your TSH is normal' , therefore "no thyroid problem exists " ?
No GP even bothered to test my TSH before deciding incorrectly i'd got post-natal depression.. despite how common thyroid issues are after a birth.. you'd like to think that the psychiatric dept. would be more switched on to the possibility of thyroid problems presenting as depression/psychosis/ etc .. but i don't know if they are .
Ah, tattybogle you made me laugh picking up my ... not bother testing. You must have had an awful time though with a new baby.
Ah no , the new baby bit was really great , i felt better physically than i had for months cos pregnancy felt awful. (and i'd never been depressed).... but then after about 3 months i possibly went a bit hyper ,, got REALLY thin, over energetic , lots of shouting that could be heard up the valley , and not being able to handle people coming round for a surprise birthday party ,( went to hide in the woods and scared them all silly ).. life got a bit messy .. then a few months later i got slower and slower, and colder and colder, and the washing up didn't get done when it should. At which point i saw GP .. who didn't test my thyroid and suggested counselling ... Duh!.. about 3/4 yrs later someone eventually checked my thyroid and said ... "Oh" ... so those 3 yrs were rather crap, to say the least.
Hi Raventhorpe, well I understand your situation completely because it sounds as if your depression was a symptom of being hypothyroid, but for instance one of my daughters, who loves life, suffers from depression which is relieved with antidepressants and she has no thyroid problem. She is very slim (size 0), very strong and active, I think T3 would make her skinny and anxious. Have I missed something? Is the suggest of T3 for depression only for those diagnosed as hypothyroid?
How many medics would consider first testing (poor) thyroid function as the possible cause of anxiety/depression!!
Anxiety is a symptom not a cause, so what causes the symptom....
I would think that unless one has a diagnosis of hypothyroidism then taking T3 to relieve anxiety is unwise. It may unnecessarily upset hormone balance causing other problems.
On the other hand if one has been diagnosed as hypothyroid then anxiety is likely to be a symptom and levothyroxine should be the initial treatment with T3 added if poor conversion is established. In this case exogenous thyroid hormone can alleviate anxiety as posts here will confirm.
Similarly people without a diagnosis of hypothyroidism are known to take T3 as an aid to losing weight, neither is this wise.
However being hypo can cause weight gain so again, when correctly treated, weight will fall.
I'm not a medic but I would be very cautious about taking T3 without a diagnosis of hypothyroidism and without discovering either poor conversion, a type of thyroid hormone resistance or tissue hypothyroidism.
It sounds like putting the cart before the horse.
T3 is a very powerful hormone and as someone who needs a high dose I've come to understand it must be used with care and respect.
My question would be..., Why are medics so reluctant to carry out thyroid tests in order to eliminate the possibility that the thyroid gland, a major organ in the body, might just hold the clue to a patient's ill health? Anxiety included!
Let's be more specific. Not just a Dx of hypothyroidism, but measurably low Free T3 should be the basis for treatment with exogenous T3. The initial goal should be to bring FT3 up into the top quartile of the range, reducing dosage if it goes above range. Then observe the impact that has on depressive symptoms. In my case the antidepressant had kept my depression under control, so the measure for success needed to be whether I could reduce the dose of my antidepressant without any ill effects.
My FT3 was below the range. Once my FT3 was at the halfway point of the range, I was able to successfully titrate down and off the antidepressant I had been taking for decades. I couldn't increase my dosage of T3 because my doctor was frightened by my low TSH (resulting from initiating treatment with T3). My dosage of levo was reduced when I began taking T3. Recently I suggested my levo back up to 150 mcg, since my FT4 was only about halfway through range at that point. This had the result of getting both FT4 and FT3 up into the top quadrant.
"Not just a Dx of hypothyroidism, but measurably low Free T3 should be the basis for treatment with exogenous T3."
So hypothyroidism, more specifically low- T3 ( the consequence of inadequate levo, poor conversion or a type of thyroid hormone resistance) was the cause of your depression. Following titration the level of replacement hormone appropriate to you enabled you to stop antidepressants.
A thyroid test had previously identified hypothyroidism/low FT3 which amongst other symptoms caused depression.
You are suggesting T3 as a treatment and I take your point but that would first necessitate a full thyroid test to establish a deficiency.
They need to join up the dots....depression: hypothyroidism: replacement hormone. But, it may also have a different cause making T3 an inappropriate treatment.
My question remains..., Why are medics so reluctant to carry out thyroid tests in order to eliminate the possibility that the thyroid gland, a major organ in the body, might just hold the clue to a patient's ill health? Anxiety included!
Some people who have a low FT3 suffer from depression which is directly related. Others have depression because they feel so unwell.
Antidepressant resistance is often treated by addition of T3 even when FT3 is optimal.
Are you a doctor? I would be very interested in being pointed to a source for these statements about T3 and depression. Is it a recent discovery?
As early as 1998: pubmed.ncbi.nlm.nih.gov/982... The thyroid axis and depression.
This is a case study from 2000. pubmed.ncbi.nlm.nih.gov/110...
Hypothyroidism and depression: a therapeutic challenge
Here is a literature study from 2000. pubmed.ncbi.nlm.nih.gov/109... Augmentation strategies for inadequate antidepressant response: a review of placebo-controlled studies
This study is from 2005: pubmed.ncbi.nlm.nih.gov/160... An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder
Hi VocalEK, sorry, there's been a misunderstanding. I know depression is linked with being hypothyroid (in the late 70s one of the first tests we did on patients referred to the 'bin' I worked in was full TFT). What I'm curious about is if T3 is being suggested for depressed people with no discernible thyroid problem. The little information given with the links you have kindly sent doesn't suggest thyroid problems were ruled out in the participants.
‘The bin’ ?
I do apologise, it was our light-hearted term in the very old days for a psychiatric hospital (looney-bin).
I do know what you meant. I find it difficult to conceive that even in the ‘very old days’ this was acceptable terminology.
You are probably right but if you had seen the devoted care given to patients in those days, compared with what I consider appalling negligence these days, you would have forgiven the language I am sure. I am soon to present evidence at an inquest following a dreadful and needless suicide so I have much stronger feelings about how people are actually treated, or denied treatment, than about the language used. I think it's how we feel towards people that motivates our behaviour and is therefore what really counts.
I’m glad that there was devoted care in these institutions but it certainly wasn’t because of the language used to describe them. In fact, in the 1970s, that terminology was no longer in use.
To use such language on a health forum and state that it was used in the 1970s in ‘ a lighthearted way’ doesn’t change my opinion that it is now, and was then, considered derogatory or offensive.
The fact that you think that how we feel about people motivates our behaviour more than the language used is not correct. Both are important and one impacts upon the other.
The crux of our caring for others lies in demonstrating respect and dignity.
As an educator for 38 years, I would show the door to any of my staff who used language which showed anything other than that.
MorecambeBay, I hear you and I'm sorry I didn't make it clear that I agree about the language, but, I think there's a misunderstanding here. I am not referring to people in a derogatory way, it was what we called the hospital, not the patients. Even so I consider negligence that results in suicide far, far, far worse. I'd rather hear sloppy language from someone who genuinely cares than the right words from uncaring professionals. Please can we drop this now? I accept your slapdown, acknowledge that it was appropriate, but no-one should take their own life because mental health professionals dismissively write-off someone's desperate pleas for help as 'showing off'. It's heart-breaking, for a whole family and friends not just the patient, and right now with the inquest forthcoming I can't get worked up about language. If you really want to pursue this please come back to me once the inquest is over and I've had time to work through the grief and distress.
I accept what you’ve said and of course I’m prepared to ‘drop it’ and I’m sorry to hear of the distressing circumstances in which you find yourself.
That said, I don’t think it’s an ‘either’ good care ‘or’ appropriate language scenario. You can and should have both.
Yes, you are probably correct. Only thing I wonder is if using terms like looney is actually better for patients, in the same way as nicknames, even if not kind, show that those using them care for the person (because we don't give nicknames to people we are indifferent to). I find this 'mental ill health' label a bit disturbing, used too broadly, for instance when referring to someone who is just suffering from feeling down in the dumps because of a life event (now often referred to as depressed) or someone who sometimes feels a bit anxious yet also the same label given to someone with raging psychosis.
"Looney", "lunatic", "bin" and other such terms are deprecated and with good reason.
Please can we have an end to this?
If you want a long discussion about the best terms for those unfortunate enough to suffer problems commonly regarded as mental health issues, there are plenty of other places. It is NOT a thyroid issue. We often have posts going off-topic, and allow a number of such topics to be discussed at length. This has nothing to do with the original post by vocalEK
From what I have seen, researchers don't seem to be at all tuned in on determining whether treatment is necessary and, if so, what dosage works best. Instead, they come up with a "standard" dose for a treatment and give that to half the subjects (the experimental group) and don't give any treatment to the other half (the control group.) When they fail to find any difference in the results between the two groups, they declare that the treatment doesn't work, when maybe the problem was inadequate dosage for the experimental group. I am speaking in general here, not just about depression and/or thyroid disorders.
IMHO, before administering T3 for any reason, the FT3 should be tested. That, however, is not necessarily how researchers approach a problem. I, on the other hand, tend to apply common sense to a problem.
I think it worth referring back to this paper from 1949:
Br Med J
. 1949 Sep 10;2(4627):555-62.
Be prepared for an upsetting experience if you decide to follow the link.
I’ve seen this before. It is very upsetting.
After my thyroidectomy and only being placed on T4 I was a raging lunatic I couldn’t control my extreme anger once T3 was added I mellowed out. Strange but definitely connected in my opinion.
This is a review of Liothyronine being used for depression published in the 'Innovations in Clinical Neuroscience in 2017;
Oops just seen that someone's already posted a link to this review.
The Guidelines for using T3 (adapted from Rosenthal 2011) [Table 3 in the article] seem quite reasonable. They don't even care if TSH is in the dump! They do guard against hyperthyroid symptoms caused by too much T3. Good call.
One thing that surprised me was the findings with adding T3 to a tri-cyclic antidepressant. The first one they gave me was Amitryptiline which immediately raised my resting heart rate to over 100 bpm. Had they added T3 to that.... When I went back to the doctor to complain about that, he sent me away telling me I would have to stay on it for 6 weeks to see if it would work. (Actually, my depressive symptoms had gotten worse. I was sleeping 18 hours a day instead of 16 and I couldn't stop crying.) I went home and then got really angry. I phoned the center again and demanded to see a different doctor ASAP. The next day I met with a very kind woman who did something the first doctor failed to do. She reached over and took my pulse. Then she said, "We can do better for you than this."
I find this really interesting. Although using T3 for depression is something that I've only become aware of since I joined this forum.
T3 has never been suggested to me despite having a long history of resistant psychiatric problems and being under the care of a psychiatrist since a teenager.
From my own experience I do feel that a gp should automatically get a patient's thyroid checked if they present with depressive symptoms and not just go straight for prescribing medication.
Also stating the obvious but that they should act on the findings and not ignore and bury them in the patient's medical record.
Over the years I've seen two psychiatrists, and despite them knowing I was hypo and taking thyroid hormones, they never once checked my levels. The second time (2007) I was taking a small dose of T3 only, much too small a dose, and in hindsight it was glaringly obvious that my dose was too low. Instead, on both occasions, they kept throwing anti D's at me. Psychiatrists are a complete waste of space in my opinion. Along with endo's.
Since I added liothyronine to my levothyroxine a year ago my mood is consistently very good and I am much less irritable and a lot calmer. If someone is experiencing depression due to hypothyroidism, and levothyroxine hasn't resolved it, I think liothyronine is a much better choice of therapy than antidepressants since it deals with the root cause of the issue. When I did dabble with antidepressants many years ago I found they gave me very unpleasant side effects and didn't help improve how I felt at all.
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