![]() 10 - 13 Major depressive disorder is common in hypothyroid patients, 10 and some 12 - 14 but not all 15, 16 studies indicate that some patients with MDD have subclinical primary hypothyroidism. 6 - 9 Alterations in hypothalamic-pituitary-thyroid axis (HPT) function may be involved in MDD. Some findings suggest a relationship between diurnal rhythm and the effects of SD: SD has been shown to alter the sleep-wake cycle, 3, 4 diurnal mood variability predicts the antidepressant effect of SD, 1, 2, 5 and phase advance and light therapy are sometimes effective in MDD. ONE NIGHT of sleep deprivation (SD) induces a rapid, albeit transient, remission in about 60% of patients with major depressive disorder (MDD), 1, 2 but the mechanism by which SD exerts its antidepressant effect is unknown. Sleep deprivation responders compensate by secreting more thyrotropin with normal bioactivity nonresponders compensate by secreting thyrotropin with increased bioactivity. Other thyroid indexes and serum cortisol concentrations were similar among groups.Ĭonclusions Depressed patients have mild compensated thyroid resistance to thyrotropin action, not subclinical autoimmune primary hypothyroidism. The bioactivity of thyrotropin in nonresponders was significantly greater than in responders (F 1,8.99 = 7.52 P =. Responders had exaggerated responses to protirelin the next afternoon. Results Nocturnal serum thyrotropin concentrations were consistently higher in responders, entirely because of elevated levels in the women reponders. To determine if the changes were limited to the hypothalamic-pituitary-thyroid axis, we measured serum cortisol, which also has a circadian secretory pattern. We measured serum thyrotropin every 15 minutes during the night of sleep deprivation, thyrotropin bioactivity, the thyrotropin response to protirelin the next afternoon, and other indexes of hypothalamic-pituitary-thyroid function. ![]() Methods We studied 18 patients with major depressive disorder and 10 normal volunteers. We wished to define precisely the status of the hypothalamic-pituitary-thyroid axis of depressed patients during sleep deprivation and the possible relationship of hypothalamic-pituitary-thyroid function to the mood response. Subclinical hypothyroidism may be associated with depression, and changes in hypothalamic-pituitary-thyroid function may affect the mood response to sleep deprivation.
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