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L-Thyroxin-Hochdosierung bei therapieresistenter Depression

Fallauswertung und Katamnese als Qualitätskontrolle

Zusammenfassung

Auf einer Depressionsstation eines Bezirkskrankenhauses wurden 28 Patienten nach 6 antidepressiven Strategien mit L-Thyroxin-Dosen von durchschnittlich 350 µg/Tag behandelt. Es kam bei 39,3% zu mäßiger und bei 21,5% zu sehr guter Besserung, gemessen am HAMD-21-Score ≤16 bzw. ≤8 und der klinischen Einschätzung. Bei 39,3% musste die Therapie wegen Erfolglosigkeit oder Nebenwirkungen abgebrochen werden. Nach 45,2 Wochen erfolgte eine Nachuntersuchung aller Schilddrüsenhormon-Responder. 28,6% der Patienten hatten L-Thyroxin abgesetzt. Bei den Therapieabbrechern gab es mit 62,5% signifikant mehr stationäre Aufenthalte als bei den Weiterbehandelten (0%), allerdings fand sich kein Unterschied in 2 verschiedenen subjektiven Ratings. Im Gegensatz zur Literatur, die bei 70 vorwiegend bipolaren Patienten keine schwerwiegenden Nebenwirkungen beschrieb, traten Herzrhythmusstörungen stationär in 10,7% und ambulant katamnestisch in weiteren 7,1% der Fälle in einer Stärke auf, die zum Absetzen führte. Insgesamt scheint daher eine systematische Untersuchung der L-Thyroxin-Hochdosistherapie bei therapieresistenten Depressionen erfolgversprechend und notwendig.

Summary

In a depression unit in a state hospital, 28 patients who had failed in six antidepressant strategies were treated with L-thyroxine at an average dose of 350 µg/die. Outcomes were moderate in 39.3% and very good in 21.5%, corresponding to 21-item HAMD scores of ≤16 and ≤8 and clinical judgement. Of all patients, 39.3% had to stop treatment due to nonresponse or side effects. Follow-up of all responders to treatment was conducted 45.2 weeks after discharge. Those 28.6% patients who had stopped treatment had significantly more readmissions, i.e., 62.5%, vs none in those who continued, whereas subjective clinical ratings did not differ between the two groups. In contrast to the literature not finding serious side effects in 70 mainly bipolar patients, we found cardial arrhythmia in 10.7% of inpatients and 7.1% of follow-up patients that was serious enough to discontinue treatment. In conclusion, systematic investigation of high-dose L-thyroxine treatment in treatment-resistant depression seems promising and necessary.

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Pfeiffer, H., Scherer, J. & Albus, M. L-Thyroxin-Hochdosierung bei therapieresistenter Depression. Nervenarzt 75, 242–248 (2004). https://doi.org/10.1007/s00115-003-1550-1

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Schlüsselwörter

  • Therapieresistente Depression
  • Hochdosis-L-Thyroxin
  • Katamnese
  • Nebenwirkungen
  • Herzrhythmusstörungen

Keywords

  • Therapy resistant depression
  • High-dose L-thyroxine
  • Follow-up
  • Side effects
  • Cardial arrhythmias