Frye M A, Denicoff K D, Bryan A L, Smith-Jackson E E, Ali S O, Luckenbaugh D, Leverich G S, Post R M
Biological Psychiatry Branch, NIMH, NIH, Bethesda, MD 20892, USA.
Am J Psychiatry. 1999 Dec;156(12):1909-14. doi: 10.1176/ajp.156.12.1909.
This investigation evaluated the relationship between changes in thyroid indices and mood stability during lithium and carbamazepine prophylaxis for bipolar disorder.
In the first 2 years, 30 patients with bipolar mood disorder were randomly assigned to 1 year of lithium and then 1 year of carbamazepine, or vice versa; in the third year, they received lithium plus carbamazepine. By stepwise regression analysis, the degree and timing of lithium- and carbamazepine-induced thyroid changes and their subsequent relationship to long-term mood stability were evaluated.
During the lithium phase, there was a significant inverse relationship between morbidity and mean serum level of free T4, i.e., a lower mean serum level of free T4 was associated with more affective episodes and greater severity of depression as shown by the Beck Depression Inventory. During the carbamazepine phase, there was an inverse relationship between mean level of total T4 and global severity rating. During the combination phase, no relationships between thyroid indices and clinical outcome were significant.
In the lithium phase, a low level of free T4 was associated with more affective episodes and greater severity of depression. Whether this mood instability is causally related to low free T4 levels and whether it can be attenuated with T4 replacement remain to be studied in a controlled setting.
本研究评估了双相情感障碍患者在使用锂盐和卡马西平进行预防治疗期间甲状腺指标变化与情绪稳定性之间的关系。
在最初的2年里，30例双相情感障碍患者被随机分配，先接受1年锂盐治疗，然后接受1年卡马西平治疗，或者反之；在第3年，他们接受锂盐加卡马西平治疗。通过逐步回归分析，评估锂盐和卡马西平引起的甲状腺变化的程度和时间及其与长期情绪稳定性的后续关系。
在锂盐治疗阶段，发病率与游离T4的平均血清水平之间存在显著的负相关关系，即游离T4的平均血清水平较低与更多的情感发作以及贝克抑郁量表所示的更严重的抑郁相关。在卡马西平治疗阶段，总T4的平均水平与总体严重程度评分之间存在负相关关系。在联合治疗阶段，甲状腺指标与临床结果之间无显著关系。
在锂盐治疗阶段，游离T4水平低与更多的情感发作和更严重的抑郁相关。这种情绪不稳定是否与游离T4水平低存在因果关系，以及是否可以通过补充T4来减轻，仍有待在对照环境中进行研究。
