s thyroiditis has been known to produce symptoms of severe anergia, f a t i p e , and depression. The hypothyroidism impairs cerebralfinction 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 jluoxetine and d-amphetamine. Despite improvement in mood with jluoxetine alone, all three patients had persistent anergia which resolved after the addition of damphetamine 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 psychostimulantsmay, in combination, providea unique treatment approach to anergic depression associated with hypothyroidism. Depression 1:llO-114 (1993).0 1993 Wiley-Lks, Inc.