Should thyroid augmentation precede lithium augmentation--a pilot study.
BACKGROUND: It has not been investigated whether thyroid augmentation should precede lithium augmentation or vice versa. METHODS: In 22 outpatients with major depression not responsive to 4 weeks of antidepressant treatment, the effect of subsequent 4 weeks of thyroxine administration followed by 4 weeks of lithium augmentation was compared with the effect of the same treatments in reverse order. RESULTS: The percentage reduction in MADRS score was significantly greater in patients who started on thyroxine. CONCLUSIONS: Thyroxine augmentation should precede lithium augmentation. LIMITATIONS: We used relatively small doses of lithium. CLINICAL RELEVANCE: Thyroxine is effective in augmenting antidepressant responses.