2004 suplement 3

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Volume 13, suplement 3

Pharmakotherapy

The assessment of hypothalamo-pituitary-thyroid axis junction in depressed patients as a factor supporting the choice of antidepressant - the preliminary study

JUSTYNA ORZECHOWSKA1, JAN M. HORODNICKI1
1. Kliniki Psychiatrii Pomorskiej Akademii Medycznej w Szczecinie
Postępy Psychiatrii i Neurologii, 2004,13, suplement 3 (19), 77-85
Keywords: depression, thyroid, antidepressants

Abstract

Aim. The presented study is a follow-up to Prof Jan M. Horodnicki's scientific work and is aimed to assess the basal secretion of TSH and thyroid hormones, T3 and T4 in depressed patients as the predictive factors of choosing the most useful selective antidepressant.

Method. The study included 54 patients hospitalized in the PAM Department of Psychiatry, within 2000-2004, diagnosed with endogenous depression, according to ICD-10. Patients were randomly assigned to two groups: treated with maprotylin (antidepressant selectively acting on the noradrenergic system) and treated with citalopram (selective serotonin reuptake inhibitor). The intensity of depressive signs and symptoms was assessed with the diagnostic scales: by Hamilton (HDRS), by Montgomely-Asberg (MADRS) and Clinical Global Impression scale (CGI), before and after 4 weeks of pharmacotherapy. Simultaneously basal serum concentration of TSH and thyroid hormones (T3 and T4) was measured.

Results. Regarding the basal secretion of TSH, T3 and T4, before treatment, the group of patients treated with maprotylin with over 50-percent reduction of depressive symptoms (n1 = 24) was similar to the group of patients treated with citalopram with no improvement (n4 = 12). The group of patients treated with maprotylin without improvement (n2 = 6), was similar to the group of patients successfully treated with citalopram (n3 = 12).

Conclusions. The present results seem to confirm the hypothesis that the disturbed balance between the central noradrenergic and serotoninergic systems responsible for the therapeutic efficacy of the selective antidepressant can be assessed on the base of TSH and thyroid hormones secretion.

Address for correspondence:
Dr Justyna Orzechowska,
Klinika Psychiatrii Pomorskiej Akademii Medycznej,
ul. Broniewskiego 26,
71-460 Szczecin