Author:
Pilhatsch Maximilian,J Stamm Thomas,Stahl Petra,Lewitzka Ute,Berghöfer Anne,Sauer Cathrin,Gitlin Michael,Frye Mark A.,Whybrow Peter C.,Bauer Michael
Abstract
Abstract
Background
Symptoms of anxiety co-occur in a variety of disorders including in depressive episodes of bipolar disorder and in patients with thyrotoxicosis. Treatment of refractory bipolar disorder with supraphysiologic doses of levothyroxine (L-T4) has been shown to improve the phenotypic expression of the disorder and is associated with an increase of circulating thyroid hormones. However, it might be associated with somatic and mental adverse effects. Here we report the investigation of the influence of treatment with supraphysiologic doses of L-T4 on symptoms of anxiety in patients with refractory bipolar depression.
Methods
Post-hoc analysis from a 6-week, multi-center, randomized, double-blind, placebo-controlled study of the effects of supraphysiologic L-T4 treatment on anxiety symptoms in bipolar depression. Anxiety symptoms were measured weekly with the Hamilton anxiety/somatization factor (HASF) score of the Hamilton Depression Rating Scale (HAMD) and the State- and Trait Anxiety Inventory (STAI).
Results
Treatment of both groups was associated with a significant reduction in anxiety symptoms (p < 0.001) with no statistical difference between groups (LT-4: from 5.9 (SD = 2.0) at baseline to 3.7 (SD = 2.4) at study end; placebo: from 6.1 (SD = 2.4) at baseline to 4.4 (SD = 2.8) at study end; p = 0.717). Severity of anxiety at baseline did not show a statistically significant correlation to the antidepressive effect of treatment with supraphysiologic doses of L-T4 (p = 0.811). Gender did not show an influence on the reduction of anxiety symptoms (females: from 5.6 (SD = 1.7) at baseline to 3.5 (SD = 2.4) at study end; males: from 6.1 (SD = 2.3) at baseline to 4.0 (SD = 2.4) at study end; p = 0.877).
Conclusions
This study failed to detect a difference in change of anxiety between bipolar depressed patients treated with supraphysiologic doses of L-T4 or placebo. Comorbid anxiety symptoms should not be considered a limitation for the administration of supraphysiologic doses of L-T4 refractory bipolar depressed patients.
Trial registration ClinicalTrials, ClinicalTrials.gov identifier: NCT01528839. Registered 2 June 2012—Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT01528839
Funder
Stanley Medical Research Institute
Publisher
Springer Science and Business Media LLC
Subject
Biological Psychiatry,Psychiatry and Mental health
Reference32 articles.
1. Bauer MS, Whybrow PC. Rapid cycling bipolar affective disorder. II. Treatment of refractory rapid cycling with high-dose levothyroxine: a preliminary study. Arch Gen Psychiatry. 1990;47:435–40.
2. Bauer M, Hellweg R, Gräf KJ, Baumgartner A. Treatment of refractory depression with high-dose thyroxine. Neuropsychopharmacol. 1998;18:444–55.
3. Bauer M, Baur H, Berghöfer A, Ströhle A, Hellweg R, Müller-Oerlinghausen B, Baumgartner A. Effects of supraphysiological thyroxine administration in healthy controls and patients with depressive disorders. J Affect Disord. 2002a;68:285–94.
4. Bauer M, Berghöfer A, Bschor T, Baumgartner A, Kiesslinger U, Hellweg R, Adli M, Baethge C, Müller-Oerlinghausen B. Supraphysiological doses of l-thyroxine in the maintenance treatment of prophylaxis-resistant affective disorders. Neuropsychopharmacol. 2002b;27:620–8.
5. Bauer M, London ED, Rasgon N, Berman SM, Frye MA, Altshuler L, Mandelkern MA, Bramen J, Woods R, Mazziotta JC, Whybrow PC. Supraphysiological doses of levothyroxine alter regional cerebral metabolism and improve mood in women with bipolar depression. Mol Psychiatr. 2005;10:456–69.
Cited by
16 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献