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Use of liothyronine in preventing electroconvulsive therapy-induced memory impairment: evaluation

  • Abbas Masoudzadeh (a1) (a2), Seyyed Taha Yahyavi (a1), Hooman Rashidi (a1), Reza Ali Mohammadpour (a1) (a3) and Reza Kiani (a4)...
Abstract
Aims and method

To evaluate the effect of liothyronine administration on the cognitive side-effects of electroconvulsive therapy (ECT), 30 participants with major depressive disorder that were suitable candidates for ECT were randomly allocated to either a liothyronine or a placebo group. Participants in the liothyronine group received a daily 50 μg dose for the whole period of receiving ECT starting the day before ECT, whereas the other group received a placebo. The Hamilton Rating Scale for Depression (HRSD) and the Wechsler Memory Scale – revised (WMS-R) were used for evaluating mood and memory before the first ECT session and after the sixth session (the HRSD was also used after the third session).

Results

The results indicated that after the sixth ECT session, participants that received liothyronine achieved significantly better scores on the HRSD and WMS-R.

Clinical implications

Further studies with a larger number of participants, through multicentre research projects, are indicated to obtain adequate data for meta-analysis and systematic review.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Seyyed Taha Yahyavi (seyyedtaha@yahoo.com)
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Declaration of interest

None.

Footnotes
References
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Use of liothyronine in preventing electroconvulsive therapy-induced memory impairment: evaluation

  • Abbas Masoudzadeh (a1) (a2), Seyyed Taha Yahyavi (a1), Hooman Rashidi (a1), Reza Ali Mohammadpour (a1) (a3) and Reza Kiani (a4)...
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eLetters

Use of liothyronine in preventing electroconvulsive therapy-induced memory impairment

Tim N. Oakley, Consultant Psychiatrist
12 March 2013

I read with interest the paper by Masoudzadeh et al (1) regarding the use of liothyronine as an adjunct to electroconvulsive therapy (ECT). In view of the relatively small sample size, the finding of improved outcome on both the Hamilton Depression Rating Scale (HDRS) and the Wechsler Memory Scale - revised (WMS-R) is encouraging.

The authors postulate that liothyronine augmentation might achieve improved cognitive performance by suppressing thyrotropin releasing hormone (TRH). TRH is anticonvulsant and decreased production might result in a lowered seizure threshold and consequently a lower stimulus dose during ECT. It would be of interest to know whether the authors found a reduction of seizure threshold in the liothyronine group when compared to the placebo group; such a finding would lend support to the proposed mechanism of action.

Depression is associated with cognitive impairment (4). The better cognitive function achieved in the liothyronine group may have been a consequence of the greater improvements in depression seen in this group rather than a consequence of TRH suppression and reduced seizure threshold. Liothyronine has been shown to improve the outcome of depression when used as an augmentation to standard antidepressant therapy (5) and it is possible that similar improvements in efficacy are observed when liothyronine is used concurrently with ECT. An analysis of the results that allows for control of the confounding effects ofthe severity of depression may be helpful, but in a small study there is an increased risk of type II error.

Many of the cognitive effects of ECT tend to normalise over time (2) and a longer term study is required to fully assess the effects on cognition of liothyronine augmentation. A longer term studymight also allow the severity of depression in both groups to equalise such that an assessment of cognitive function independent of the severity of depression is possible.

Notwithstanding these limitations the study is a welcome addition to the literature, although it is the improved outcome in depression achieved by the addition of liothyronine that might turn out to be the most significant finding.

References

1.Masoudzadeh A, Yahyavi ST, Rashidi H, RAMohammadpour, Kiani R. The Psychiatrist 2013; 37:49-53. Use of liothyronine in preventing electroconvulsive therapy-induced memory impairment: evaluation

2.Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson M. Neuropsychopharmacology 2007; 32(1):244-54. The cognitive effects of electroconvulsive therapy in community settings

3.McElhiney M, Moody B, Sackeim H. The Autobiographical Memory Interview -Short Form. New York: New York State Psychiatric Institute; 1997

4.Austin MP, Mitchell P and Goodwin GM. Br J Psychiatry 2001; 178:200-206. Cognitive deficits in depression: Possible implications for functional neuropathology

5.Joffe RT, Singer W, Levitt AJ, MacDonald C. Arch Gen Psychiatry 1993; 50(5):387-393. A placebo-controlledcomparison of lithium and triiodothyronine augmentation of tricyclic antidepressants in unipolar refractory depression

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Conflict of interest: None declared

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