• Hashimoto's thyroiditis;
  • anergia;
  • fatigue;
  • depression;
  • fluoxetine;
  • d-amphetamine


Hashimoto's thyroiditis has been known to produce symptoms of severe anergia, fatigue, and depression. The hypothyroidism impairs cerebral function causing marked motor slowing which complicates the treatment of concomitant depression. In this open trial, three patients with documented Hashimoto's thyroiditis and Major Depression responded to a combination of fluoxetine and d-amphetamine. Despite improvement in mood with fluoxetine alone, all three patients had persistent anergia which resolved after the addition of d-amphetamine to their regimen. A discussion of the unique aspects of anergia and depression associated with hypothyroidism follows, with a focus on the cerebral impairment and delayed reaction time that complicates this illness. The neurotransmitter enhancing properties of serotonin re-uptake inhibitors and direct-acting psychostimulants may, in combination, provide a unique treatment approach to anergic depression associated with hypothyroidism. Depression 1:110–114 (1993). © 1993 Wiley-Liss, Inc.