Severe depression is associated with higher thyrotropin (TSH) levels, according to study findings intended to be presented at the annual meeting of the Endocrine Society (ENDO 2020).

Knowing that hypothyroidism has been previously associated with mood disorders, researchers investigated the association between TSH levels and severe depression in adult patients in a historical cohort study. Between October 2016 and July 2019, consecutive patients were included if they had both a TSH and patient health questionnaire-9 (PHQ-9) assessment recorded within 6 months of their index visit to the University of Utah healthcare system. Electronic records were used to extract data on demographics, TSH level, PHQ-9, hypothyroidism, antidepressant medications, and thyroid hormone replacement therapy. Among patients with mood disorders who were not diagnosed with overt hypothyroidism, a subgroup analysis was performed comparing euthyroid patients (TSH level, 0.3-4 mU/L) and patients with subclinical hypothyroidism (TSH level, 4-10 mU/L).

Among 26,722 individuals in the cohort (mean age, 46.3 years; 68% women; 79.5% white), the mean PHQ-9 score was 8.2. Overall, 10% of patients had severe depression (PHQ-9 score ≥20), 26% were taking mood stabilizers, 51% were taking antidepressants, 19% were diagnosed with hypothyroidism, and 20% were receiving thyroid hormone replacement therapy. Patients with severe depression were more likely to be taking antidepressants (P <.0001) and have a higher mean TSH level (P =.06). A positive correlation was seen between TSH concentration and PHQ-9 score (P =.04), and after adjusting for potential covariates, TSH level was associated with severe depression (odds ratio, 1.006; 95% CI, 1.003-1.009).

Compared with patients with hypothyroidism who did not receive thyroid hormone replacement therapy, those who did receive treatment had a lower mean PHQ-9 score (P <.0001). Individuals with a TSH level between 7 and 10 mU/L had higher PHQ-9 scores compared with those who had a TSH level between 4 and 7 mU/L (P <.003).


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The investigators suggested that future randomized controlled trials “should evaluate the effect of [thyroid hormone replacement] in (a) patients with severe depression and (b) patients with mood disorders who have subclinical hypothyroidism.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Sundaresh V, Newman M, Bakian AV, Abraham D, Singh B. The association between thyroid stimulating hormone and severe depression: a historical cohort study. J Endocr Soc. 2020;4(suppl 1):SAT-457.

This article originally appeared on Endocrinology Advisor