甲状腺刺激激素“略高于正常水平”的重度抑郁症患者是否应优先使用三环类药物治疗？

Should major depression with 'high normal' thyroid-stimulating hormone be treated preferentially with tricyclics?

作者信息

Corruble Emmanuelle, Berlin Ivan, Lemoine Antoinette, Hardy Patrick

机构信息

Psychiatry Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, PSIGIM, Paris XI University, Kremlin Bicêtre, France.

出版信息

Neuropsychobiology. 2004;50(2):144-6. doi: 10.1159/000079105.

DOI:10.1159/000079105

PMID:15292668

Abstract

In a prospective and naturalistic setting, two samples representing 209 depressed inpatients were assessed for thyroid functioning at admission before antidepressant treatment, and for depression before and after 1 month of antidepressant treatment. We hypothesized that serum thyroid-stimulating hormone (TSH) elevation > or = upper 25th percentile of the normal reference range is associated with poorer response to antidepressant therapy and differences between tricyclic antidepressants (TCA) and other antidepressants. Screening for mild thyroid failure defined as serum TSH concentrations > or = upper 25th percentile of the normal range may provide clues to the clinician. Such patients have a more severe form of depression and a slower or impaired response to antidepressant therapy. It is also possible that they would benefit preferentially from TCA rather than other antidepressants.

摘要

在一项前瞻性自然主义研究中，对代表209名抑郁症住院患者的两个样本进行了评估，在入院时抗抑郁治疗前检测甲状腺功能，并在抗抑郁治疗1个月前后检测抑郁情况。我们假设血清促甲状腺激素（TSH）升高≥正常参考范围的第25百分位数上限与抗抑郁治疗反应较差以及三环类抗抑郁药（TCA）和其他抗抑郁药之间的差异有关。筛查定义为血清TSH浓度≥正常范围第25百分位数上限的轻度甲状腺功能减退可能为临床医生提供线索。这类患者患有更严重形式的抑郁症，对抗抑郁治疗反应较慢或受损。他们也有可能优先从TCA而非其他抗抑郁药中获益。