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[crazepharmacist]

Hi, I am looking for advice on how to get this medication prescribed. I have sub-clinical hypothroidism according to my endocrinologist but she will only prescribe a trial of t4(synthroid). My reverse t3 is high as well so I want to try a course of cytomel to see if any of my symptoms improve. I am located in the states. From my research apparently psychiatrists will prescribe it for "treatment resistant depression". I have been on SSRIS before with little to no affect on my mood. My current therapist said prescribing cytomel to increase the effectiveness of antidepressants has been clinically tried and proven but he does not do it. He told me to go through an endo. I will try calling another psychiatrist but before I do I just want to see if anyone has advice for this here. Thanks.

[Tom_]

triiodothyronine is commonly prescribed in subclinical hypothyoidism when there is treatment resistant depression. It is on occation used with normal thyoid functioning in TRD. While I have heard of liothyronine being used for depression its a second line less evidence based treatment.

If you are looking for any prescription it should be triiodothyronine.

I would give the L-thyroxine a chance, its a first line treamtent in hypothryoidism. If you still have symptoms as shown by serum thyoid tests then return to the endo and follow what ever treatment algorithm they prescribe it will likely include some form of T3 prescription. If your Thyroid function improves and your mood doesn't, you should be looking into supplementing with another psych drug, I would recommend lithium (its contraindictated in your case due to hypothyroidism) as its the most studied adjunct or a switch outside the SSRI class (I assume you have tried 2+ SSRI's?). Vanlafaxine or mirtazapine, depending on symptoms. If you are tired, anhedonic and your mood doesn't change much vanlafaxine is a good bet. If you are agitated, suffer from insomnia, lack of appetite and are bothered by suffering sexual side effects mirtazapine might be a good call.

Increased rT3 doesn't mean you need T3 as a treatment, it could lead to even further dysregulation. T4 will reduce TSH production and T3 will normalize by itself in most cases. Have you/your endo considered iodine defiency?