EFFECTS OF NOCTURNAL TRH ADMINISTRATION ON TSH, MOOD, AND MOTOR ACTIVITY

一晚清晨睡眠剥夺（PSD： 患者清醒0200-2100小时）产生急性但短暂的 超过60%的双相情感障碍患者有抗抑郁反应。 直到最近， PSD几乎没有临床效用，因为其效果在48 小时 然而，四项研究已经证明， 治疗维持了睡眠剥夺的急性抗抑郁作用 无限期地，没有杂环诱导躁狂的风险。 虽然有效，但睡眠剥夺是麻烦的;患者经常 怀疑并说服他们接受它，或者继续一次 开始，很难。 无论我们如何理解这些中介因素，我们也许能够 绕过睡眠剥夺，转而使用调解器。 的 下丘脑-甲状腺轴（HPT）可能是这种介质。夜间TSH 双相抑郁症的分泌减少， 成功的治疗。 PSD增加TSH和TSH水平升高 与抗抑郁作用有关。 TSH 对患有以下疾病的患者产生急性但短暂的抗抑郁作用： 萧条 急性期的描述之间的相似性，但 PSD和TRH的短暂抗抑郁作用是显著的。 我们 假设睡眠剥夺的抗抑郁作用是由于 HPT刺激下丘脑或垂体水平。 我们将 在清晨给予TRH或安慰剂， 抑郁受试者，以确定对TSH，情绪和运动活动的影响。 我们预测TRH会增加夜间TSH水平并产生相同的- 白天，但短期，情绪和运动增加。 我们希望将这项研究得出的数据作为初步数据， 开展一项关于HPT轴、抗抑郁药和 锂/PSD和锂/TRH在双相情感障碍中的运动效应

One night of sleep deprivation during the early morning hours (PSD: patient awake 0200-2100 hours) produces an acute, but transient antidepressant response in over 60% of bipolar subjects. Until recently, PSD has shown little clinical utility because its effects wane within 48 hours. However, four studies have now documented that concurrent lithium treatment maintains the acute antidepressents effects of sleep deprivation indefinitely, void of heterocyclic-induced mania risk. While effective, sleep deprivation is cumbersome; patients are often skeptical and persuading them to undergo it, or continue with it once begun, is difficult. If, however we understood the mediating factors, we might be able to bypass sleep deprivation and administer the mediator instead. The hypothalmic-thyroid axis (HPT) may be such a mediator. Nocturnal TSH secretion is reduced in bipolar depression and normalizes with successful treatment. PSD increases TSH and increases in TSH levels during sleep deprivation correlate with antidepressant effect. TSH produces an acute, but transient, antidepressant effect in patients with depression. The similarities between the descriptions of the acute, but transient, antidepressant effects of PSD and TRH are striking. We postulate that the antideressant effects of sleep deprivation are due to HPT stimulation at the level of the hypothalalmus or pituitary. We will administer TRH or placebo during the early morning hours to bipolar depressed subjects to determine effects on TSH, mood, and motor activity. We predict that TRH will increase nocturnal TSH levels and produce same- day, but short-term, increases in mood and locomotion. We hope to use the data derived from this study as initial data for developing a prospective study of the HPT axis, antidepressant, and locomotor effects of lithium/PSD and lithium/TRH in bipolar illness.