Thyroid and adrenal axis in major depression: a controlled study in outpatients
Thyroid and adrenal axis in major depression: a controlled study in outpatients
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DOI：
10.1530/eje.1.01828
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发表时间：
2005-02-01
影响因子：
5.8
通讯作者：
Fliers, E
中科院分区：
文献类型：
--
作者：
Brouwer, JP;Appelhof, BC;Fliers, E
目的：重度抑郁症与下丘脑-垂体-甲状腺（HPT）轴的变化和皮质醇增多症有关。然而，报告的变化存在差异，可能与住院或门诊患者状态、抗抑郁药物的使用以及抑郁症的异质性有关。因此，我们对至少 3 个月未使用抗抑郁药物的单相抑郁门诊患者进行了一项对照研究。设计：我们评估了 113 名抑郁症门诊患者以及 113 名性别和年龄匹配的对照者的内分泌参数。方法：根据《精神疾病诊断和统计手册》(DSM) 第四版 (SCID-IV) 的结构性临床访谈，如果患者患有重度抑郁症，并且如果他们有17 项汉密尔顿抑郁量表（HRSD）得分大于或等于 16。内分泌参数包括血清 TSH 浓度、（游离）甲状腺素、三碘甲状腺原氨酸、皮质醇、甲状腺过氧化物酶 (TPO) 抗体滴度和 24 小时尿皮质醇排泄量。 结果：与对照组相比，抑郁症患者的 TSH 血清浓度略高（P < 0.001），与亚临床甲状腺功能减退症和/或 TPO 抗体的存在无关（n = 28）。两组的所有其他 HPT 轴参数相似。患者和对照组的 24 小时尿皮质醇排泄量相似。非典型抑郁症患者的血清皮质醇低于非典型抑郁症患者（P = 0.01）。既没有忧郁抑郁症也没有严重抑郁症（HRSD大于或等于23）的患者内分泌参数发生了改变。最后，血清TSH值与皮质醇值不存在相关性。结论：与匹配的对照组相比，门诊重性抑郁症患者的血清TSH略高，而尿皮质醇水平相似。此外，我们观察到非典型抑郁症患者的血清皮质醇低于非典型抑郁症患者。
Objective: Major depressive disorder has been associated with changes in the hypothalamus - pituitary-thyroid (HPT) axis and with hypercortisolism. However, the changes reported have been at variance, probably related to in- or outpatient status, the use of antidepressant medication and the heterogeneity of depression. We therefore conducted a controlled study in unipolar depressed outpatients who had been free of antidepressants for at least 3 months.Design: We assessed endocrine parameters in 113 depressed outpatients and in 113 sex- and age-matched controls.Methods: Patients were included if they had a major depression according to a Structural Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM), fourth edition (SCID-IV) and if they had a 17-item Hamilton rating scale for depression (HRSD) score of greater than or equal to16. Endocrine parameters contained serum concentrations of TSH, (free) thyroxine, tri-iodothyronine, cortisol, thyroid peroxidase (TPO) antibody titre and 24-h urinary excretion of cortisol.Results: The serum concentration of TSH was slightly higher in depressed patients as compared with controls (P < 0.001), independent of the presence of subclinical hypothyroidism and/or TPO antibodies (n = 28). All other HPT axis parameters were similar in both groups. The 24-h urinary cortisol excretion was similar in patients and controls. In atypical depression, serum cortisol was lower than in non-atypical depression (P = 0.01). Patients with neither melancholic depression nor severe depression (HRSD greater than or equal to 23) had altered endocrine parameters. Finally, serum TSH values could not be related to cortisol values.Conclusion: When compared with matched control subjects, outpatients with major depression had slightly higher serum TSH, while urinary cortisol levels were similar. Furthermore, we observed lower serum cortisol in atypical depression than in non-atypical depression.