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Endocrine changes and clinical profiles in depression: II. The thyrotropin-releasing hormone test

Published online by Cambridge University Press:  09 July 2009

S. P. Calloway ,
R. J. Dolan ,
P. Fonagy ,
V. F. A. De Souza  and
A. Wakeling
S. P. Calloway*
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital, London
R. J. Dolan
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital, London
P. Fonagy
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital, London
V. F. A. De Souza
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital, London
A. Wakeling
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital, London
*
1 Address for correspondence: Dr S. P. Calloway, Academic Department of Psychiatry, Royal Free Hospital, Pond Street, London NW3 2QG
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Synopsis

Thirty-one (43%) of 68 patients with primary depression were found to have a blunted thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH). Increased thyroid activity, as measured by the free thyroxine index (FTI), was present in 16 (24%) of the patients. Patients with blunted responses had a higher mean FTI level than those with normal responses. Patients with blunted responses were significantly more likely to exhibit the symptoms of depersonalization, derealization and agitation. There was no clear association between blunting and any particular diagnostic category of depression.

Patients with blunted responses and high FTI values were more likely to report significant long-term environmental difficulties than patients with blunted responses and normal FTI values. It is suggested that there may be more than one mechanism responsible for blunting of the TSH response in depressed patients. In some patients blunting may be due to negative feedback from increased output of thyroid hormones, possibly released as part of a stress response. In other patients blunting may be due to a different mechanism, possibly involving pituitary gland dysfunction. These mechanisms would not necessarily be mutually exclusive in any one patient.

Type
Research Article
Information
Psychological Medicine , Volume 14 , Issue 4 , November 1984 , pp. 759 - 765
Copyright
Copyright © Cambridge University Press 1984

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