Kelly Tammas, Lieberman Daniel Z
The Depression & Bipolar Clinic of Colorado, 315 West Oak Street, Fort Collins, Colorado 80525, USA.
J Affect Disord. 2009 Aug;116(3):222-6. doi: 10.1016/j.jad.2008.12.010. Epub 2009 Feb 11.
Thyroid hormone plays a role in both serotonin and catecholamine functions in the brain, and has been linked to abnormal mood states in bipolar disorder. Unlike most studies which have included only patients with bipolar I, this study evaluated triiodothyronine (T3) as an augmentation agent for treatment-resistant depression in patients with bipolar II and bipolar disorder NOS.
This study was a retrospective chart review of patients treated in a private clinic between 2002 and 2006. The charts of 125 patients with bipolar II disorder and 34 patients with bipolar disorder NOS were reviewed.
Patients had been unsuccessfully treated with an average of 14 other medications before starting T3. At an average dose of 90.4 mcg (range 13 mcg-188 mcg) the medication was well tolerated. None of the patients experienced a switch into hypomania, and only 16 discontinued due to side effects. Improvement was experienced by 84%, and 33% experienced full remission.
The limitations are those associated with the retrospective chart review design.
A high percentage of bipolar II and bipolar NOS patients with treatment resistant depression improved on T3. Despite the use of higher than usual doses in many of the patients, the medication was well tolerated. Augmentation with supraphysiologic doses of T3 should be considered in cases of treatment resistant bipolar depression.
甲状腺激素在大脑中的血清素和儿茶酚胺功能中均发挥作用，并且与双相情感障碍中的异常情绪状态有关。与大多数仅纳入双相I型患者的研究不同，本研究评估了三碘甲状腺原氨酸（T3）作为双相II型和未特定型双相情感障碍患者难治性抑郁症的增效剂。
本研究是一项对2002年至2006年在一家私人诊所接受治疗的患者的回顾性病历审查。审查了125例双相II型障碍患者和34例未特定型双相情感障碍患者的病历。
患者在开始使用T3之前平均已接受过14种其他药物的治疗但均未成功。平均剂量为90.4微克（范围为13微克至188微克）时，该药物耐受性良好。没有患者转为轻躁狂发作，只有16例因副作用停药。84%的患者病情有所改善，33%的患者完全缓解。
局限性在于与回顾性病历审查设计相关的那些问题。
高比例的双相II型和未特定型双相情感障碍难治性抑郁症患者使用T3后病情改善。尽管许多患者使用的剂量高于通常剂量，但该药物耐受性良好。对于难治性双相抑郁症患者，应考虑使用超生理剂量的T3进行增效治疗。
