The effect of liothyronine supplementation on electroconvulsive therapy-induced cognitive impairment in patients with mood disorders: a clinical trial

Document Type : Original Article

Authors

1 Department of Psychiatry, School of Medicine, Kashan University of Medical Science, Kashan, Iran

2 Department of Addiction Studies, School of Medicine AND Clinical Research Development Unit, Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran

Abstract

Objectives: This study aimed to assess the effects of Liothyronine supplementation on memory performance in patients diagnosed with mood disorders (major depressive or bipolar disorder).
Methods: This double-blind controlled clinical trial was conducted on patients with major depression and bipolar disorder. The participants were randomly assigned to either the intervention group receiving Liothyronine or the placebo group, with 33 patients in each group, for a duration of one month. Memory performance was assessed before the first, fourth, and final ECT sessions, as well as one month after the last session using the Wechsler Memory Scale-Revised (WMS-R). Data analysis was performed using independent-samples Chi-square test and the Greenhouse-Geisser correction factor.
Results: Liothyronine significantly enhanced communicative learning and visual memory in patients with major depression and bipolar disorder one month after the final ECT session. Additionally, a positive effect of Liothyronine on immediate recall was observed before the last ECT session.
Conclusion: Liothyronine supplementation improves ECT-induced cognitive impairment in patients with major depression and bipolar disorder. Further research is necessary to fully comprehend the potential of Liothyronine as an adjunctive treatment for major depression and bipolar disorder.

Keywords

References

  1. Mirghaed M, Gorji H, Panahi S. Prevalence of Psychiatric Disorders in Iran: A Systematic Review and Meta-analysis. Int J Prev Med. 2020;11(1). doi:10.4103/ijpvm.IJPVM_489_18 PMid:32577194 PMCid:PMC7297433
  2. Grant RL, Waselkow DC, McIntyre SB. Blinders to Comprehensive Psychiatric Diagnosis. Public Heal Behind Bars From Prison to Communities Second Ed. 2021;313-25. doi:10.1007/978-1-0716-1807-3_20
  3. Sadock B, Sadock V, Ruiz P. Preparations and Doses of Medications Acting on the Benzodiazepine Receptor Available in the United States. Synop Psychiatry. 2015;949.
  4. Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med 2007; 357(19):1939-45. doi:10.1056/NEJMct075234 PMid:17989386
  5. Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 5th ed.
  6. Stryjer R, Ophir D, Bar F, Spivak B, Weizman A, Strous RD. Rivastigmine treatment for the prevention of electroconvulsive therapy-induced memory deficits in patients with schizophrenia. Clin Neuropharmacol. 2012;35(4):161-4. doi:10.1097/WNF.0b013e31825e7945 PMid:22751086
  7. Landry M, Moreno A, Patry S, Potvin S, Lemasson M. Current Practices of Electroconvulsive Therapy in Mental Disorders: A Systematic Review and Meta-Analysis of Short and Long-Term Cognitive Effects. J ECT. 2021;37(2):119-27. doi:10.1097/YCT.0000000000000723 PMid:33009218
  8. Jones SV, McCollum R. Subjective memory complaints after electroconvulsive therapy: systematic review. BJPsych Bull. 2019; 43(2):73-80. doi:10.1192/bjb.2018.45 PMid:30860456 PMCid:PMC6472304
  9. Prudic J, Fitzsimons L, Nobler MS, Sackeim HA. Naloxone in the prevention of the adverse cognitive effects of ECT: a within-subject, placebo controlled study. Neuropsychopharmacology. 1999;21(2):285-93. doi:10.1016/S0893-133X(99)00015-9 PMid:10432476
  10. Prakash J, Chaudhury S, Chatterjee K, Kotwal A, Srivastava K, Saha A. Therapeutic and prophylactic role of cognitive enhancers in electroconvulsive therapy-induced cognitive deficits. Ind Psychiatry J. 2019;28(2):286. doi:10.4103/ipj.ipj_105_20 PMid:33223724 PMCid:PMC7660005
  11. Rao NP, Palaniyappan P, Chandur J, Venkatasubramanian G, Gangadhar BN. Successful use of donepezil in treatment of cognitive impairment caused by maintenance electroconvulsive therapy: a case report. J ECT. 2009;25(3):216-8. doi:10.1097/YCT.0b013e3181926ada PMid:19190508
  12. Duma A, Maleczek M, Panjikaran B, Herkner H, Karrison T, Nagele P. Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy: A Systematic Review and Meta-analysis. Anesthesiology. 2019;130(1):83. doi:10.1097/ALN.0000000000002488 PMid:30557212 PMCid:PMC6300062
  13. Matthews JD, Blais M, Park L, Welch C, Baity M, Murakami J, et al. The impact of galantamine on cognition and mood during electroconvulsive therapy: A pilot study. J Psychiatr Res. 2008; 42 (7):526-31. doi:10.1016/j.jpsychires.2007.06.002 PMid:17681545
  14. Kaykhaei MA, Shahraki MR, Mohammadi M, Moshtaghian B, Zandkarimi M. The Effects of Topical Application of Thyroid Hormone (Liothyronine, T3) on Skin Wounds in Diabetic Wistar Rats. Zahedan J Res Med Sci. 2016;18(4):6449. doi:10.17795/zjrms-6449
  15. Jain KK. Drug-Induced Disorders of Memory and Dementia. Drug-induced Neurol Disord. 2021;209-31. doi:10.1007/978-3-030-73503-6_14 PMCid:PMC8562829
  16. Andrade C, Shaikh SA, Narayan L, Blasey C, Belanoff J. Administration of a selective glucocorticoid antagonist attenuates electroconvulsive shock-induced retrograde amnesia. J Neural Transm. 2012;119(3):337-44. doi:10.1007/s00702-011-0712-8 PMid:21922193
  17. Andrade C, Bolwig TG. Electroconvulsive therapy, hypertensive surge, blood-brain barrier breach, and amnesia: exploring the evidence for a connection. J ECT. 2014;30(2):160-4. doi:10.1097/YCT.0000000000000133 PMid:24800688
  18. Mousavi SG, Mohsen G, Reza MM, Amrollah E, Majid B, Fariba N. Efficacy of Memoral Herbal on Prevention of Electroconvulsive Therapy-Induced Memory Impairment in Mood Disorder Patients (Isfahan - Iran 2011). Int J Prev Med. 2012;3(7):499.
  19. Al-Mosawi A. Leadership in Medicine and Healthcare: An Overview of the Emerging Concepts and Principles. Lupine Online J Med Sci. 2019;4(1):344-51.
  20. Prakash J, Kotwal A, Prabhu HRA. Therapeutic and prophylactic utility of the memory-enhancing drug donepezil hydrochloride on cognition of patients undergoing electroconvulsive therapy: a randomized controlled trial. J ECT. 2006;22(3):163-8. doi:10.1097/01.yct.0000230365.81368.2d PMid:16957530
  21. Stepien BK, Huttner WB. Transport, Metabolism, and Function of Thyroid Hormones in the Developing Mammalian Brain. Front Endocrinol (Lausanne). 2019;10(APR). doi:10.3389/fendo.2019.00209 PMid:31001205 PMCid:PMC6456649
  22. Khaleghzadeh-Ahangar H, Talebi A, Mohseni-Moghaddam P. Thyroid Disorders and Development of Cognitive Impairment: A Review Study. Neuroendocrinology. 2022;112(9):835-44. doi:10.1159/000521650 PMid:34963121
  23. Patel T, Brod B, Ahmed S, Khoja M, Sainvil F, Rizvi S. Chronic Thromboembolic Pulmonary Hypertension (CTEPH) presenting as a right atrial myxoma- A case report and review of the literature. Novel Clin Med 2023; 2(4): 209-218. doi: 10.22034/ncm.2023.407925.1100
  24. Tost M, Monreal JA, Armario A, Barbero JD, Cobo J, García-Rizo C, et al. Targeting Hormones for Improving Cognition in Major Mood Disorders and Schizophrenia: Thyroid Hormones and Prolactin. Clin Drug Investig. 2020;40(1):1-14. doi:10.1007/s40261-019-00854-w PMid:31612424
  25. Verdijk JPAJ, van Kessel MA, Oud M, Kellner CH, Hofmeijer J, Verwijk E, et al. Pharmacological interventions to diminish cognitive side effects of electroconvulsive therapy: A systematic review and meta-analysis. Acta Psychiatr Scand. 2022;145(4):343-56. doi:10.1111/acps.13397 PMid:35075641 PMCid:PMC9305858
  26. Mohagheghi A, Arfaie A, Amiri S, Nouri M, Abdi S, Safikhanlou S. Preventive effect of liothyronine on electroconvulsive therapy-induced memory deficit in patients with major depressive disorder: A double-blind controlled clinical trial. Biomed Res Int. 2015;2015. doi:10.1155/2015/503918 PMid:25945337 PMCid:PMC4402486
  27. Masoudzadeh A, Yahyavi ST, Rashidi H, Mohammadpour RA, Kiani R. Use of liothyronine in preventing electroconvulsive therapy-induced memory impairment: evaluation. Psychiatrist. 2013;37(2):49-53. doi:10.1192/pb.bp.111.038398
  28. Touma KTB, Zoucha AM, Scarff JR. Liothyronine for Depression: A Review and Guidance for Safety Monitoring. Innov Clin Neurosci. 2017;14(3-4):24.
  29. Orangi M, Atefvahid MK, Ashayeri H. Standardization of the Revised Wechsler Memory Scale in Shiraz. Iran J Psychiatry Clin Psychol . 2002;7(4):56-66.
  30. Uma D, Rabbani R, Lee JH, Gavini DR, Shah PH, Hamid P. Does hormone supplementation with levothyroxine improve hypothyroid impaired cognitive dysfunction? Cureus. 2021; 13 (9). doi:10.7759/cureus.17885
  31. Duma A, Maleczek M, Panjikaran B, Herkner H, Karrison T, Nagele P. Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive TherapyA Systematic Review and Meta-analysis. Anesthesiology. 2019;130(1):83-91. doi:10.1097/ALN.0000000000002488 PMid:30557212 PMCid:PMC6300062
  32. Bassa A, Sagués T, Porta-Casteràs D, Serra P, Martínez-Amorós E, Palao DJ, et al. The Neurobiological Basis of Cognitive Side Effects of Electroconvulsive Therapy: A Systematic Review. Brain Sci. 2021;11(10). doi:10.3390/brainsci11101273 PMid:34679338 PMCid:PMC8534116
  33. Andrade C. Reconsideration of the Benefits of Pharmacological Interventions for the Attenuation of the Cognitive Adverse Effects of Electroconvulsive Therapy. J Clin Psychiatry. 2022;83(5). doi:10.4088/JCP.22f14668
  34. Malhi GS, Ivanovski B, Hadzi-Pavlovic D, Mitchell PB, Vieta E, Sachdev P. Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia. Bipolar Disord. 2007;9(1-2):114-25. doi:10.1111/j.1399-5618.2007.00324.x PMid:17391355
  35. Nuñez NA, Sola C, Kung S, Singh B, Ozerdem A, Veldic M, et al. Deiodinase variation and liothyronine treatment interaction to accelerate ECT response in major depression: Pilot data and implications for thyroid pharmacogenomic testing in mood disorders. Pers Med Psychiatry. 2021;29-30:100089. doi:10.1016/j.pmip.2021.100089
  36. Tremont G, Stern RA. Minimizing the cognitive effects of lithium therapy and electroconvulsive therapy using thyroid hormone. Int J Neuropsychopharmacol. 2000;3(2):175-86. doi:10.1017/S1461145700001838 PMid:11343594
International Archives of Health Sciences
Volume 11, Issue 1
February 2024
Pages 49-55

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History

  • Receive Date: 29 July 2023
  • Revise Date: 07 September 2023
  • Accept Date: 17 September 2023

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