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Effect of Antidepressant Medication on Morning and Evening Thyroid Function Tests During a Major Depressive Episode

Fabrice Duval, MD; Marie-Claude Mokrani, PhD; Marc-Antoine Crocq, MD; Martine Jautz, MAPsych; Paul Bailey, MRCPsych; Than-Son Diep, MD; Jean-Paul Macher, MD
Arch Gen Psychiatry. 1996;53(9):833-840. doi:10.1001/archpsyc.1996.01830090081012.
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Background:  This study sought to determine whether changes in thyroid function that may occur during antidepressant treatment are related to a direct effect of the drug on the thyroid axis or to a change in clinical state.

Methods:  Morning and evening thyroid function was evaluated in 30 euthyroid inpatients who met DSM-IV criteria for major depressive episode, by determination of free triiodothyronine, free thyroxine, and thyrotropin levels before and after 8 AM and 11 PM protirelin challenges (200 μg intravenously), on the same day. Results at baseline were compared with those after 1 month of antidepressant treatment with either amitriptyline hydrochloride, fluoxetine hydrochloride, or toloxatone.

Results:  Clinical efficacy and effects on thyroid function did not differ across the 3 antidepressant drugs. Compared with pretreatment values, significant reductions in basal serum 8 AM free thyroxine, 11 PM free thyroxine, and 8 AM free triiodothyronine levels and increases in 11 PM maximum increment in plasma thyrotropin level and the difference between 11 PM and 8 AM maximum increment in plasma thyrotropin values were observed in responders (n=11) but not in partial responders (n=6) or nonresponders (n=13). Moreover, nonresponders exhibited lower pretreatment 11 PM thyrotropin values (basal and maximal increment above basal) than responders.

Conclusions:  The results suggest that (1) changes in thyroid function are related to clinical recovery rather than to a direct effect of the antidepressant drug and (2) patients with the lowest pretreatment evening thyrotropin secretion have the lowest rate of antidepressant response, and this may contribute to treatment resistance.

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