PTSD, SSRIs, and T3



Gents, breaking up a thread I put up about people on thyroid meds, etc, I also mentioned that t3 appears to augment the effects of SSRIs. Several strudies listed in that thread on that:

However, I wanted to bring specific attention to the fact that the effects of SSRIs with t3 and its effects on PTSD have been examined and the were in line with the other studies that found benefits with the SSRI + t3 combo. So, if you are on SSRIs for PTSD and not getting benefit from it, this may be something to talk to your prescribing physician about. I know a few people that have used this combo for PTSD and they felt it was very effective for them. FYI, t3 is the active thyroid hormone the body uses and does need to be followed via blood tests.

J Clin Psychiatry. 2001 Mar;62(3):169-73. Links
Triiodothyronine augmentation of selective serotonin reuptake inhibitors in posttraumatic stress disorder.

* Agid O,
* Shalev AY,
* Lerer B.

Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

BACKGROUND: There is considerable comorbidity of major depression and posttraumatic stress disorder (PTSD), and antidepressants have been reported to be effective in treating PTSD. Addition of triiodothyronine (T3) to ongoing antidepressant treatment is considered an effective augmentation strategy in refractory depression. We report the effect of T3 augmentation of antidepressants in patients with PTSD. METHOD: T3 (25 microg/day) was added to treatment with a selective serotonin reuptake inhibitor (SSRI) (paroxetine or fluoxetine, 20 mg/day for at least 4 weeks and 40 mg/day for a further 4 weeks) of 5 patients who fulfilled DSM-IV criteria for PTSD but not for major depressive disorder (although all patients had significant depressive symptoms). The Clinician-Administered PTSD Scale, the 21-item Hamilton Rating Scale for Depression, and the Clinical Global Impressions-Severity of Illness scale were administered every 2 weeks, and self-assessments were performed with a 100 mm visual analog mood scale. RESULTS: In 4 of the 5 patients, partial clinical improvement was observed with SSRI treatment at a daily dose of 20 mg with little further improvement when the dose was raised to 40 mg/day. This improvement was substantially enhanced by the addition of T3. Improvement was most striking on the Hamilton Rating Scale for Depression. CONCLUSION: T3 augmentation of SSRI treatment may be of therapeutic benefit in patients with PTSD, particularly those with depressive symptoms. Larger samples and controlled studies are needed in order to confirm this observation.
If one SSRI isn't doing the job you need to get your psych to try another. it took 3 tries to get something that worked properly, and one reason that I left the national center for PTSD is because of the fact that they were flipping me around on my medication so much, to stuff already tried and found lacking/painful/further aggrivating/hallucination causing, that I got fed up with that approach coupled with the fact that I have never been a "touchy feely feelgood" type... type A for aggressive since birth...

One problem with shrinks is that normal is based off of a normal that not all people were/are/will be... I know for a fact I'm not your average individual, mentally physically or socially. I'm not changing who I am for the whim of a shrink... because i'm not "normal"
If one SSRI isn't doing the job you need to get your psych to try another.

Nothing wrong with that but the studies find even with people that tried several SSRIs and failed to benefit, the addition of t3 helped; so far t3 has augmented the effects of all SSRIs it's been used with (i think 6 types, but have to look that up) and if it improves the effects of what ever SSRI you are using, I say try it.
Regarding the above info, I gave that info to a psychiatrist I know who is a mucky muck in the area and works at one of the big hospitals in the area in addition to his own practice. He’s tried this with some patients who did not respond well to any of the SSRIs he tried and or stopped benefiting from them.

According to him, the addition of t3 has had “miraculous” effects on some of the patients who had failed to benefits from other drugs and drug combinations. He’s used 10-15mcg of t3 he told me. He said his only frustration with the strategy was you could not tell who it was going to be affective for and who it would not, but he said in the people it was effective with, the improvements were “miraculous.”

No one should undertake t3 therapy without medical supervision, but this feedback in addition to the studies above, etc, it very much mat be worth talking to your prescribing physician about it if you are not getting the benefits from SSRIs or are not longer benefiting from them as you once did, etc.
T3's also been used in cutting cycles hasn't it?

Yup, it's a common drug with bodybuilders etc, though they use much higher doses which can be dangerous, especially when added to the mega poly pharmacy they engage in :uhh:
As I was doing some research, this study may explain one mechanism by which t3 augments the effects of the SSRI's:

J Neurosci Methods. 2005 Feb 15;141(2):335.

Effects of triiodothyronine and fluoxetine on 5-HT1A and 5-HT1B autoreceptor activity in rat brain: regional differences.

Lifschytz T, Gur E, Lerer B, Newman ME.

Biological Psychiatry Laboratory, Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

The thyroid hormone triiodothyronine (T3) augments and accelerates the effects of antidepressant drugs. Although the majority of studies showing this have used tricyclics, a few studies have shown similar effects with the selective serotonin re-uptake inhibitor (SSRI) fluoxetine. In this study we investigated the effects of fluoxetine (5 mg/kg), T3 (20 microg/kg) and the combination of these drugs, each administered daily for 7 days, on serotonergic function in the rat brain, using in vivo microdialysis. Fluoxetine alone induced a trend towards desensitization of 5-HT1A autoreceptors as shown by a reduction in the effect of 8-OH-DPAT to lower 5-HT levels in frontal cortex, and desensitized 5-HT1B autoreceptors in frontal cortex. The combination of fluoxetine and T3 induced desensitization of 5-HT1B autoreceptors in hypothalamus. Since there is evidence linking hypothalamic function and depression, we suggest that this effect may partly account for the therapeutic efficacy of the combination of an SSRI and T3.