Several studies, mainly performed in outpatients, suggest that triiodothyronine (T3) addition may convert depressed patients who are nonresponders to tricyclic antidepressants (TCAs) into responders. This study is to our knowledge the first study of T3 augmentation performed in severely depressed inpatients. In our study no evidence for the efficacy of adjunctive T3 treatment was found in a sample of 14 inpatients. T3 augmentation was performed over a four-week period; during the last three weeks the daily dosage was 37.5 micrograms. The patients involved were suffering from refactory depression and previously had not responded to an adequate six-week course of treatment with a TCA (mainly nortriptyline). Many of the patients were suffering from depression with melancholic and/or psychotic features. During follow-up, eleven of the patients responded to further treatment with either an MAOI or electroconvulsive therapy.
Oince the discovery in the late 1950's of imipramine (Tofranil®), the first tricyclic antidepressant (TCA), and iproniazid, the first monoamine oxidase inhibitor (MAOI), many other TCAs and MAOIs, now being considered the classical antidepressants, have become available. Their effectiveness has been shown in numerous studies, although according to nowadays standards well designed studies (placebo-controlled, defined diagnostic groups, the use of standardized rating scales) with these compounds are relatively scarce. From the early 1980's the so called modern antidepressants have been introduced: the selective serotonin re-uptake inhibitors (SSRIs), the reversible selective monoamine oxidase-A inhibitors (RIMAs) and a variety of other compounds. All these drugs have been registered after their effectiveness had been shown in well designed, placebo-controlled studies. In defining the efficacy of antidepressants, registration authorities consider two aspects important: statistical evidence and clinical relevance.
In a study in 97 patients on the occurrence of disturbances of liver functions by use of long acting neuroleptic drugs (fluphenazine decanoate, flupenthixol decanoate and fluspirilene) no indications were found that these agents, even in relatively high dosages, are hepatotoxic. Furthermore, in 40% of the patients slight disturbances were found, which nevertheless, were not specific in nature, and mostly concerned the turbidity tests. In spite of these findings a regular control (for instances, once a year) of the liver functions in patients with long acting neuroleptic drugs seems to be called for.
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