title: Thyroid and adrenal axis in major depression: a controlled study in outpatients.
abstract: OBJECTIVE
  Major depressive disorder has been associated with changes in the hypothalamus-pituitary-thyroid (HPT) axis and with hypercortisolism. However, the changes reported have been at variance, probably related to in- or outpatient status, the use of antidepressant medication and the heterogeneity of depression. We therefore conducted a controlled study in unipolar depressed outpatients who had been free of antidepressants for at least 3 months.
  
  
  METHODS
  We assessed endocrine parameters in 113 depressed outpatients and in 113 sex- and age-matched controls.
  
  
  METHODS
  Patients were included if they had a major depression according to a Structural Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM), fourth edition (SCID-IV) and if they had a 17-item Hamilton rating scale for depression (HRSD) score of > or =16. Endocrine parameters contained serum concentrations of TSH, (free) thyroxine, tri-iodothyronine, cortisol, thyroid peroxidase (TPO) antibody titre and 24-h urinary excretion of cortisol.
  
  
  RESULTS
  The serum concentration of TSH was slightly higher in depressed patients as compared with controls (P < 0.001), independent of the presence of subclinical hypothyroidism and/or TPO antibodies (n = 28). All other HPT axis parameters were similar in both groups. The 24-h urinary cortisol excretion was similar in patients and controls. In atypical depression, serum cortisol was lower than in non-atypical depression (P = 0.01). Patients with neither melancholic depression nor severe depression (HRSD > or =23) had altered endocrine parameters. Finally, serum TSH values could not be related to cortisol values.
  
  
  CONCLUSIONS
  When compared with matched control subjects, outpatients with major depression had slightly higher serum TSH, while urinary cortisol levels were similar. Furthermore, we observed lower serum cortisol in atypical depression than in non-atypical depression.
authors.affiliation: Department of Endocrinology, University of Amsterdam, Amsterdam, The Netherlands. j.p.brouwer@amc.uva.nl
authors.forename: Jantien P
authors.initials: JP
authors.lastname: Brouwer
authors.forename: Bente C
authors.initials: BC
authors.lastname: Appelhof
authors.forename: Witte J G
authors.initials: WJ
authors.lastname: Hoogendijk
authors.forename: Jochanan
authors.initials: J
authors.lastname: Huyser
authors.forename: Erik
authors.initials: E
authors.lastname: Endert
authors.forename: Cassandra
authors.initials: C
authors.lastname: Zuketto
authors.forename: Aart H
authors.initials: AH
authors.lastname: Schene
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Richard
authors.initials: R
authors.lastname: Van Dyck
authors.forename: Wilmar M
authors.initials: WM
authors.lastname: Wiersinga
authors.forename: Eric
authors.initials: E
authors.lastname: Fliers
mesh_terms: D000311:Adrenal Glands / Q000502:physiology*; D000328:Adult; D003267:Contraception; D003865:Major Depressive Disorder / Q000097:blood / Q000145:classification / Q000503:physiopathology*; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D007453:Iodide Peroxidase / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D013961:Thyroid Gland / Q000502:physiology*; D013972:Thyrotropin / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
chemical_list: D004967:Estrogens; D014284:Triiodothyronine; D013972:Thyrotropin; D007453:Iodide Peroxidase; D006854:Hydrocortisone