Brady K T, Anton R F
Department of Psychiatry, Medical University of South Carolina, Charleston 29425-0742.
Biol Psychiatry. 1989 Mar 15;25(6):703-9. doi: 10.1016/0006-3223(89)90241-2.
Although there has been much recent investigation of the role of thyroid function in affective illness, few studies have addressed the effects of the tricyclic antidepressants on the pituitary-thyroid axis. In the present study, thyroid functions (TFTs) and thyrotropin-releasing hormone (TRH) stimulation of thyroid-stimulating hormone (TSH) were measured before and after treatment with desipramine (DMI) in 13 men with a diagnosis of major depressive disorder. All subjects had normal TFTs and baseline TSH measured in a drug-free state at the initiation of the study. Both mean free thyroxine index and baseline TSH decreased after DMI treatment. The amount of decrease in baseline TSH correlated with increase in delta TSH. Four subjects had blunted delta TSH (delta TSH less than or equal to 5 microIU/ml); three of these subjects "normalized" with treatment (delta TSH less than or equal to 5 microIU/ml; greater than or equal to 20 microIU/ml). Two subjects had a high delta TSH, and both "normalized" during treatment. The decrease in both free T4 index and TSH suggests a down-regulation of the thyroid axis at the hypothalamic level. "Normalization" of subtle dysregulation of the thyroid axis is suggested as a mechanism of antidepressant therapy in the treatment of some depressions.
尽管最近对甲状腺功能在情感性疾病中的作用进行了大量研究，但很少有研究探讨三环类抗抑郁药对垂体 - 甲状腺轴的影响。在本研究中，对13名诊断为重度抑郁症的男性患者在接受去甲丙咪嗪（DMI）治疗前后测量了甲状腺功能（TFTs）以及促甲状腺激素释放激素（TRH）刺激促甲状腺激素（TSH）的情况。所有受试者在研究开始时处于无药状态下的TFTs和基础TSH均正常。DMI治疗后，平均游离甲状腺素指数和基础TSH均下降。基础TSH的下降量与TSH变化量（delta TSH）的增加相关。4名受试者的TSH变化量降低（delta TSH小于或等于5微国际单位/毫升）；其中3名受试者经治疗后“恢复正常”（delta TSH小于或等于5微国际单位/毫升；大于或等于20微国际单位/毫升）。2名受试者的TSH变化量升高，且两者在治疗期间均“恢复正常”。游离T4指数和TSH的下降表明下丘脑水平的甲状腺轴下调。甲状腺轴细微失调的“恢复正常”被认为是抗抑郁治疗在某些抑郁症治疗中的一种机制。
