Thyroid and adrenal axis in major depression: a controlled study in outpatients.
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.
Brouwer
Jantien P
JP
Department of Endocrinology, University of Amsterdam, Amsterdam, The Netherlands. j.p.brouwer@amc.uva.nl
Appelhof
Bente C
BC
Hoogendijk
Witte J G
WJ
Huyser
Jochanan
J
Endert
Erik
E
Zuketto
Cassandra
C
Schene
Aart H
AH
Tijssen
Jan G P
JG
Van Dyck
Richard
R
Wiersinga
Wilmar M
WM
Fliers
Eric
E
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
D004967:Estrogens; D014284:Triiodothyronine; D013972:Thyrotropin; D007453:Iodide Peroxidase; D006854:Hydrocortisone