Thyroid Hormone Treatment of Mood Disorders

AbstractPurpose of reviewBoth excess and insufficient thyroid hormones can lead to depression that is generally reversible with adequate thyroid treatment. On the other hand, major depression is associated with subtle chronobiological hypothalamic-pituitary-thyroid (HPT) axis dysregulation and thyroid hormones can be an effective adjunct to antidepressant treatment. However, the links between HPT axis status and efficacy of thyroid hormone supplementation in depression remain to be further clarified.Recent findingsWhile generally, depressed patients are chemically euthyroid, most exhibit a chronobiological HPT axis dysregulation (i.e., loss of the nocturnal thyrotropin [TSH] rise, blunted evening TSH response to protirelin [TRH], reduced difference in TSH response between 11 PM and 8 AM TRH tests [ ΔΔTSH]), possibly associated with blunted 8 AM-TSH response to TRH and/or altered levels of circulating thyroxine (FT4) and triiodothyronine (T3). Usually, chronobiological HPT axis abnormalities are unrelated to increased cortisol levels. Normalization of thyroid function tests by antidepressants , especially the ΔΔTSH test, may occur before the clinical response. In patients who are resistant to antidepressants, there is good evidence for adjuvant therapy with thyroid hormones.SummaryWhile there is a limited evidence base to guide long-term adjunctive use, thyroid hormone augmentation can be a safe and effective alternative treatment for euthyroid-depressed patients who recei...
Source: Current Treatment Options in Psychiatry - Category: Psychiatry Source Type: research