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Thyrotropin-releasing hormone Thyroid hormones Severe depression Paroxetine
Abstract
There are very divergent appraisals of the effect of antidepressants on thyroid parameters and their possible correlation with the response. Whereas there are numerous investigations of tricyclic antidepressants, so far, there are only limited data on the possible effect of serotonin-selective reuptake inhibitors on neuroendocrine parameters. The present study showed a significant reduction of 11.2% in thyroxine during treatment with 20 mg paroxetine in 25 severely depressed patients.
Copyright 2000 S. Karger AG. Basel
Introduction
Correlations between the induction and course of depressive illness and disturbance along the hypothalamus-- pituitary-thyroid (HPT) axis have been observed [1, 2]. The influence of antidepressants on thyroid function is controversial [3]; there are, however, consistent results documenting a reduction of thyroxine (T4), and in some instances free thyroxine (FT4), that correlate with a response in the course of tricyclic antidepressant treatment [4, 5]. During treatment with the serotonin-selective reuptake inhibitor (SSRI) fluoxetine, a significant reduction in triodothyronine (T3) has been observed [6]. This study group therefore discussed the question as to whether SSRIs have different effects on the HPT axis than tricyclic antidepressants. It also could be demonstrated that endogenous depressive female patients showed blunted thyroid-stimulating hormone (TSH) response after releasing hormone application [7]. This did not show any effect on thyroid parameters. The objective of the present study, therefore, was to investigate a possible effect of paroxetine on the thyrotropin-releasing hormone (TRH) test, T3 and T4 in a group of depressed inpatients.
Methods
Subjects
Twenty-five depressed patients consecutively admitted to our depression treatment unit ( 10 men, 15 women) were included in the investigation. Their average age was 41 years (SD 12.58, range 2063 years). The patients had no thyroid diseases in their history. They had not been administered thyroid hormone substitution or lithium in the last 6 months. Pregnancy, serious somatic illness or addiction also were exclusion criteria. All patients received a physical and laboratory examination. Nine patients (36%) expressed notions of suicide at the time of admission, 6 patients (24%) had been admitted after attempted suicide, and 11 patients (44%) were not suicidal on admission. The depressive symptoms fulfilled criteria for major depression (single or recurrent, without psychotic features according to DSM-IV [8]....