Prange A J
Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill 27599-7160, USA.
Thyroid. 1996 Oct;6(5):537-43. doi: 10.1089/thy.1996.6.537.
Hormones of the thyroid axis have been used to treat patients with any of several mental illnesses. However, in recent decades interest has focused almost exclusively on depression, though thyroid hormones, mainly thyroxine (T4), are used with lithium in rapid cycling bipolar disorder, a condition in which depression and mania rapidly alternate. In depression L-triiodothyronine (T3) has been used in preference to T4 because of its rapid onset and offset of action. In women starting treatment, T3 hastens the onset of therapeutic action of standard antidepressant drugs. It fails to do so in depressed men, who anyway respond faster than women to standard antidepressants. Standard drugs fail to produce satisfactory improvement in one-quarter to one-third of depressed patients. Then, in both men and women, T3 converts about two-thirds of drug failures to successes in rapid fashion. Lithium, which has antithyroid properties, produces a similar conversion rate. The majority of depressed patients are grossly euthyroid, but many show one or another subtle change in thyroid axis activity. However, the thyroid state of patients has not been matched systematically with their response to thyroid hormone augmentation. It seems likely that a tendency toward hypothyroidism can predispose to depression, but when depression occurs in a euthyroid patient, the thyroid axis is often invoked in the process of restitution.
甲状腺轴激素已被用于治疗多种精神疾病患者。然而，近几十年来，人们几乎只关注抑郁症，尽管甲状腺激素，主要是甲状腺素（T4），在快速循环双相情感障碍中与锂联合使用，快速循环双相情感障碍是一种抑郁和躁狂快速交替的疾病。在抑郁症治疗中，左旋三碘甲状腺原氨酸（T3）因其起效和作用消失迅速而比T4更受青睐。在开始治疗的女性中，T3能加速标准抗抑郁药物的治疗作用起效。在抑郁男性中则不然，无论如何，男性对标准抗抑郁药的反应比女性更快。标准药物在四分之一到三分之一的抑郁症患者中未能产生令人满意的改善效果。然后，在男性和女性中，T3能迅速将约三分之二治疗失败的患者转变为治疗成功的患者。具有抗甲状腺特性的锂也能产生类似的转化率。大多数抑郁症患者甲状腺功能大致正常，但许多患者在甲状腺轴活动方面表现出一种或另一种细微变化。然而，患者的甲状腺状态与其对甲状腺激素增强治疗的反应尚未系统匹配。甲状腺功能减退倾向似乎可能易引发抑郁症，但当甲状腺功能正常的患者出现抑郁症时，甲状腺轴常在恢复过程中被激活。
