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T4 for treatment resistant depression

Middleway

Middleway

Ex-Bluelighter
Joined
Apr 10, 2007
Messages
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Location
Melbourne
Hi

I have been taking nardil for about a year now and it is not working nearly as well as it used to..I recently approached my doctor with a clinical study where they used T4 to elavate patients t4 levels to 150% of the baseline to augment various psychiatric drugs.
http://www.psycheducation.org/thyroid/T4BauerReview2003.pdf

Anyway, if you read it it says that it was effective and well tolerated and recomends increasing to 400mcg in 4 weeks

I have been on it for a week and the first few days were magic! I still feel better but the side effects are starting to come through. Irritablity, anger, and labile mood.
Anyone have any clue as to whether this will subside as my body gets used to it? Maybe I need something else on top?
Conventional wisdom says go to a psychietrist I know but I hate the barstards! All they want to do is fill me up on antipsychotics and the nardil has made me fat enough so for that and other reasons I refuse them.
So they throw their hands up and say the only other option is therapy.
Useless pricks
Any advice would be appreciated, cheers...oh and please at least read the study first if your planning to harang me about taking T4
Thanks
 
wow that seems like it would have just as many (but very different) unpleasant side effects as antidepressants. im interested in what happens with this. do you feel more motivated?

you mentioned anti-psychotics. is there something besides depression going on as well?

anyway, i suppose a beta blocker might help you with some of the physical effects. ask your doc about it though before you go taking anything.
 
I have stopped taking it now after a week, made me too labile and irritable.
I am at my wits end. Nothing works, its not fair I should feel so shit all the fucking time
 
I like how phenelzine's side effects include both weight gain and weight loss. Not sure how that works, but I imagine it just breaks all of your appetite control mechanisms.

Anyway, get yourself some Tianeptine -- some of the smartest people I know say it's the best antidepressant they've ever had, and it comes with fewer side effects than most. One word of warning: don't inject it.

Also, regular intense exercise, three meals a day, 9 hours of sleep a night. It works wonders.
 
^how does tianeptine interact with maois? I would think it doesn't, but it's such an oddball. There's research out there maybe? The mechanisms of phenelzine and tianeptine seem contradictory.

I took levothyroxine at a clip of 150 micrograms per day for a few months and never noticed a thing.
 
^yeah but they write that on the prescribing info for every antidepressant (more or less). I don't see any clinical data on pubmed for tianeptine+maoi and it's not like they can compare it to all the other reuptake enhancers.

Not saying the combo is ok or anything; just curious.
 
I believe tianeptine can have a mild stimulant effect, so perhaps thats why it might be contraindicated with maois?

Hard to find any info on this.
 
really if your depression cannot be shifted by chemicals you should have a look into cognitive behavioural therapy and how changing your thought processes can improve things.

i'm not lying, as its a bit chicken and egg syndrome, but the way you think can reinforce depressive tendencies and vice versa. look at how you think!
 
Thanks for your replies
I actually think the t4 was potentiated by the phenelzine which made me overstimulated.

Actually I have cut the dose right back now and I am realising that I have been quite overstimulated from nardil the whole time I was on it.

I would be keen to try Tianeptine but it is bloody expensive and from what I have read, it isnt quite the wonder drug it is made out to be.

At the moment I am thinking of try aourix for a 3rd time (it always made me agitated as hell) and adding carbamazpine into the mix.

Cant stand this weight gain any more, its making me miserable
 
I'm intending to ask my psychiatrist about T4 when I see him today, so it's really good to read about someone's personal experience with it.
 
atara said:
Anyway, get yourself some Tianeptine -- some of the smartest people I know say it's the best antidepressant they've ever had, and it comes with fewer side effects than most. One word of warning: don't inject it.
Click to expand...

Everyone's just a little different, so what medication works (if any) will vary. For me, Tianeptine caused some serious side effects, including dizziness and anxiety. However, a low dose of Abilify did the trick, relieving my depression when all sorts of other things had failed.
 
do they really play with the thyroid like this in australia?
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In the U.S., too. Thyroid hormone augmentation for treatment-resistant depression has enjoyed consistent, moderate success for over 30 years, with a very good safety record.

T4 for treatment resistant depression
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I took levothyroxine at a clip of 150 micrograms per day for a few months and never noticed a thing.
Click to expand...

As there doesn't appear to be any strong indication that disturbed T4 levels are a primary feature of most depressive disorders, the active metabolite, T3 is a much better bet for augmentation or monotherapy, apparently in even euthyroid patients. Also, thyroxine is known to have a very real potential to be converted into inactive, and even counteractive metabolites, a risk that appears amplified in those suffering from affective disorders:

http://www.ncbi.nlm.nih.gov/pubmed/6417704

Unless you have genuine clinical hypothyroidism, levothyroxine's therapeutic utility will likely be short-lived, and considerably limited [at best], especially when compared to the truly active hormone, 3, 3', 5-triiodothyronine, which is both equally well-studied and seemingly more effective for psychiatric indications than its inactive, haphazard precursor.
 
^^^

When I brought it up with my shrink last week, he was all about T3 (apparently it had been a hot topic at a conference he attended in Hong Kong). He's fine about prescribing it once I'm stable, but not before. It's also an expensive option here.
 
It's also an expensive option here
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Really? The last time I UTSFEd, I think I read that a Mylan-produced generic had been recently approved by the U.S. FDA. I'm guessing you still have to rely upon the brand label (Tertroxin, or something, isn't it?). Sorry to hear it.
 
P A said:
Really? The last time I UTSFEd, I think I read that a Mylan-produced generic had been recently approved by the U.S. FDA. I'm guessing you still have to rely upon the brand label (Tertroxin, or something, isn't it?). Sorry to hear it.
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It's not to do with the patent (a lot of drug patents expire here before they do in the US) in this case, it's because it's only subsidised for use in treating hypothyroidism in patients where other treatments have failed. It's not uncommon for drugs to be subsidised for some uses but not for others here. Lamotrigine is another drug which is subsidised for one indication - epilepsy - but not for others.
 
It's not to do with the patent (a lot of drug patents expire here before they do in the US) in this case, it's because it's only subsidised for use in treating hypothyroidism in patients where other treatments have failed.
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I gotta tell you...that sounds awful. I had no idea that the notion of an 'off-label' indication had no meaning for Australian practitioners/healthcare policy makers. Damn shame, really. Though I'm not such a huge fan of the plutocratic 'rich get better, poor get sicker' system we currently employ, I suppose I should thank christ for my privileged healthcare consumer rights (like the right to choose which drugs I'm prescribed, for whatever reason, at equitable price).

When federally allocated healthcare goes wrong? Or is it an insurance issue? Or do you need/have insurance? [Pardon my ignorance and typical U. S. political chauvinism.]
 
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^^^

For the most part, the PBS system works and keeps literally thousands of commonly used drugs affordable to everyone and a few stunningly expensive medications available to those who need them. Many, many drugs are subsidised for off-label uses but getting new off-label uses approved for subsidy without significant research to back up such use is difficult. And drug companies don't want to run expensive trials to validate an off-label use for a relatively small market. Essentially they need to prove that their drug is both more effective and has less side effects than existing drugs which are subsidised for the same indication.

That said, the drugs can be prescribed. It's just that Australians are used to paying a set maximum amount for our prescriptions and so anything which is double or triple that amount seems absurdly expensive - even if it's still cheaper here than elsewhere in the world (it often is because of the way our government purchases drugs from manufacturers). It's because of the reluctance on the part of consumers to pay more than a set amount that we've avoided some of the dramas about off-label use which have plagued some medications elsewhere - atypical antipsychotics and the hundreds of millions of dollars in fines related to their off-label use and the continuing lawsuits over their off-label use spring to mind.

People who have "extras" cover on their private health insurance do benefit somewhat if they have unsubsidised prescriptions but there's an annual limit on rebates for unsubsidised prescriptions (the coverage is worth nothing if all your medications are subsidised). There's a safety net which operates for subsidised prescriptions and once that amount is reached low income earners will receive any further subsidised medication free for the remainder of the year and average people will pay a much reduced co-payment.

As elsewhere, there's always a push for approval of promising new treatments to be fast-tracked and there's always an outcry when medications which have been fast-tracked for approval turn out to have more significant risks than was apparent in early trials.
 
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