Reversible Paroxetine-Induced Symptomatic Hypothyroidism

Non-linear relationship between TSH and psychotic symptoms on first episode and drug naïve major depressive disorder patients: a large sample sized cross-sectional study in China

INTRODUCTION

Psychotic depression (PD) is characterized by the co-occurrence of emotional dysfunction and psychotic symptoms such as delusions and hallucinations with poor clinical outcomes. TSH may involve in the development of PD. This study aims to explore relationship between TSH and PD.

METHODS

A total of 1718 outpatients diagnosed as FEDN MDD were recruited in this study. The relationship between PD and TSH was evaluated using multivariable binary logistic regression analysis. To assess the presence of non-linear associations, a two-piecewise linear regression model was employed. Furthermore, interaction and stratified analyses were conducted with respect to sex, education, marital status, comorbid anxiety, and suicide attempt.

RESULTS

Multivariable logistic regression analysis revealed that TSH was positively associated with the risk of PD after adjusting for confounders (OR = 1.26, 95% CI: 1.11 to 1.43; p < 0.05). Smoothing plots showed a nonlinear relationship between TSH and PD, with the inflection point of TSH being 4.94 mIU/L. On the right of the inflection point, for each unit increase in serum TSH level on the right side of the inflection point, the probability of PD increased substantially by 47% (OR = 1.47, 95% CI: 1.25 to 1.73, p < 0.001), while no significant association was observed on the left side of the inflection point (OR = 0.87, 95% CI: 0.67 to 1.14, p = 0.32).

CONCLUSION

Our investigation showed a nonlinear TSH-PD relationship in FEDN MDD patients, thus contributing to effective intervention strategies for psychotic symptoms in depression patients.

Abnormal Thyroid Function Laboratory Results Caused by Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressant Treatment

Mental health issues, especially depressive disorders, are major burdens to the health care systems. This has been more pronounced since the onset of the COVID-19 pandemic. Selective serotonin reuptake inhibitors (SSRIs) are often prescribed for depression. Uncommonly appreciated, however, are the adverse effects these agents may have on thyroid function laboratory test results as well as the clinical thyroidal functional status of such patients, which may lead to erroneous diagnoses and inappropriate treatments. We report on a depressed woman who developed abnormal thyroid biochemical laboratory reports during fluoxetine therapy. After changing to the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine, the thyroid laboratory reports were normalized. In light of this, we wish to alert treating clinicians to this potential significant adverse effect.

Mirtazapine use may increase the risk of hypothyroxinaemia in patients affected by major depressive disorder

AIMS

Hypothyroxinaemia could be easily neglected if attention is paid only to patients with elevated thyroid-stimulating hormone. We aimed to assess the association between mirtazapine use and hypothyroxinaemia in patients affected by major depressive disorder.

METHODS

We conducted a retrospective cohort study in the Second Affiliated Hospital of Xinxiang Medical University between January 2016 and December 2018. Patients affected by major depression disorder and admitted to the hospital for treatment during the study period and who had thyroid tests at admission and after treatment were included. Mirtazapine use during hospitalization was the exposure measure and newly developed hypothyroxinaemia was as the primary outcome and structure parameters of thyroid homeostasis were the secondary outcomes of this study. Log-binomial model was used to estimate the association between mirtazapine use and hypothyroxinaemia, after adjusting for potential confounding factors.

RESULTS

A total of 220 eligible patients were included in the final analysis. The incidence of hypothyroxinaemia in patients who used mirtazapine was higher (37.5%) than those patients who did not use (19.7%). The relative risk of developing hypothyroxinaemia was 1.70 (95% confidence interval: 1.21-2.43) for mirtazapine use, after adjusting for confounding factors. The degree of reduction in thyroid feedback quantile-based index in mirtazapine group was significantly greater than that in nonmirtazapine group.

CONCLUSION

Mirtazapine use was associated with the increased risk of developing hypothyroxinaemia. The underlying mechanism may be involved the changed central set point of thyroid homeostasis, in which pituitary was in a possibly impaired sensitivity to the lower level of thyroid hormones.

Reversible Fluoxetine-Induced Hyperthyroidism: A Case Report

Background

Selective serotonin reuptake inhibitors (SSRIs) are typically used as antidepressants. Clinically significant SSRI-induced thyroid dysfunction is rare.

Case

We report a case of hyperthyroidism induced by fluoxetine in a female patient with major depressive disorder. Her thyroid profiles indicated hyperthyroidism after a 10-week treatment with fluoxetine and were restored after discontinuation of fluoxetine and administration with venlafaxine. In the first year of follow-up, her thyroid functions as well as her depressive symptoms remained perfectly normal.

Conclusions

This case highlights the necessity of monitoring thyroid profiles during SSRI treatment.

Escitalopram-induced subclinical hypothyroidism. A case report

Several conditions and drugs induce subclinical hypothyroidism. We report a case of asymptomatic and reversible subclinical hypothyroidism in a 48-year old woman with minor depressive disorder receiving therapy with escitalopram 20 mg daily for six months.

Reversible escitalopram-induced hypothyroidism

Some drugs can cause alterations in the concentration of thyroid hormones in blood even without clinical signs of dysfunction or pathology of the thyroid gland. Apart from the well-known relationship between depression and hypothalamic-pituitary-thyroid (HPT) axis, and the impact of selective serotonin reuptake inhibitors (SSRIs) on thyroid indices, hypothyroidism is a very rare adverse effect of SSRI treatment. However, the case presented here demonstrates that escitalopram may have the potential to induce hypothyroidism without any significant clinical signs and symptoms. Therefore, the possibility of SSRI-induced asymptomatic hypothyroidism presented here may help clinicians in this regard.

Current awareness: Pharmacoepidemiology and drug safety

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