Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-27T18:05:02.608Z Has data issue: false hasContentIssue false
  • English
  • Français

The thyrotropin-releasing hormone test in depressed and non-depressed psychiatric patients

Published online by Cambridge University Press:  28 April 2020

M. Maes ,
P. Hobin ,
M. De Ruyter  and
E. Suy
M. Maes
Affiliation:
Psychiatrie Center St-Jozef, Abdijstraat, 2, 3751Munsterbilzen, Belgium
P. Hobin
Affiliation:
Psychiatrie Center St-Jozef, Abdijstraat, 2, 3751Munsterbilzen, Belgium
M. De Ruyter
Affiliation:
Psychiatrie Center St-Jozef, Abdijstraat, 2, 3751Munsterbilzen, Belgium
E. Suy
Affiliation:
Psychiatrie Center St-Jozef, Abdijstraat, 2, 3751Munsterbilzen, Belgium
Get access

Summary

The thyrotropin-releasing hormone (TRH) test was carried out in 231 depressed patients undergoing a dexamethasone suppression test (DST), and in 63 psychiatric control patients. The patients were classified according to DSM-III. Thyrotropin-secreting hormone (TSH) was determined in basal conditions, 20 and 60 min after the administration of 200 μg TRH. The Δ max TSH values (peak TSH response minus basal TSH) showed no significant difference between psychiatrie Controls and patients with major depression (296.00X2, 296.00X3, 296.00X4) or with depression (major and minor depression; 300,40, 296,82, 309.00). Consequently, the TRH test is not specifie either for depression or for major depression. Within the selected group of depressive patients, major depressives showed significantly (P<0.005) lower Δ max TSH responses than minor depressives. The TRH test could barely be used as a clinical diagnostic aid for major depression, since the predictive value for a positive test resuit was too low (maximal 70.2%). To separate major from minor depression, a single DST was more suitable than the TRH test or the combination of both tests. Age showed a negative correlation (P<0.005) with the Δ max TSH responses and could be considered as a predisposing factor for a blunted TSH response to TRH in depressive patients.

Résumé

Résumé

Le test au TRH (hormone thyréotrope hypothalamique) a été réalisé chez 231 malades déprimés et 63 patients psychiatriques témoins chez qui un test à la dexaméthasone (DST) avait été pratiqué. Les diagnostics des malades étaient faits selon le DSM III. La sécrétion de thyrotropine (TSH) était mesurée à l‘état basal 20 et 60 min après l‘administration de 200 ng de TRH. Le Δ max TSH (valeur maximale moins valeur basale) ne montre aucune différence entre les cas témoins, les patients présentant les épisodes dépressifs majeurs (296.X2, 296.X3, 296.X4) ou des troubles dépressifs: 300.40, 296.82, 309.00. Il semble donc que le test au TRH ne soit spécifique ni des troubles dépressifs ni des troubles dépressifs majeurs. Parmi le groupe de troubles dépressifs, il semble exister un Δ max de la réponse TSH plus bas chez les épisodes «majeurs» (P<0,005). Le test peut donc difficilement être utilisé comme une aide au diagnostic clinique des troubles dépressifs majeurs car la valeur prédictive d‘un test positif est basse (maximum 70,2%). Un seul résultat du DST est capable de séparer les épisodes majeurs et mineurs mieux que le test au TRH ou la combinaison de 2 tests. L‘âge est négativement corrélé au Δ max de la réponse TSH (P<0,005) et doit donc être considéré comme un facteur prédisposant les sujets âgés à une réponse TSH au TRH diminuée dans les troubles dépressifs.

Keywords

depressionthyrotropin-releasing hormone testdexamethasone suppression testdépressionhormone thyréotrope hypothalamiquetest de freinage par la dexaméthasone
Type
Original article
Information
Psychiatry and Psychobiology , Volume 3 , Issue 6 , 1988 , pp. 373 - 379
Copyright
Copyright © European Psychiatric Association 1988

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aggernaes, H.Kirkegaard, C. & Krog-Mcyer, I. (1983) Dexamethasone suppression test and TRH test in endogenous depression. Acta Psychiatr. Scand. 67, 258–264CrossRefGoogle ScholarPubMed
Baumgartner, A.Hahnenkamp, L. & Meinhold, H. (1986) The effect of age and diagnosis on thyrotropin response to thyrotropin releasing hormone (TRH) in psychiatric patients. Psychiatr. Res. 17, 285–292CrossRefGoogle Scholar
Brown, W.A. & Shuey, I. (1980) Response to dexamethasone and subtype of depression. Arch. Gen. Psychiatry 37, 747–751CrossRefGoogle ScholarPubMed
Carroll, B.J.Curtis, G.C. & Mendels, J. (1976) Neuroendocrine regulation in depression. Arch. Gen. Psychiatry 33, 1039–1044CrossRefGoogle ScholarPubMed
Carroll, B.J. (1980) Clinical application of neuroendocrine research in depression. In: Handbook of Biological Psychiatry, Part III: Brain Mechanisms and Abnormal Behavior - Genetics and Neuroendocrinology (Van Praag, H.M., Lader, H.M., Rafaelsen, O.J. and Sachar, E.J., eds.), Marcel Dekker, New York, pp. 179–193Google Scholar
Cohen, J. (1960) A coefficient of agreement for nominal scales. Ed. Psychol. Meas. 20, 37–46CrossRefGoogle Scholar
DSM III (1980) Diagnostic and Statistical Manual of Mental Disorders. American Psychiatrie Association, Washington, DC, 3rd edn.Google Scholar
Extein, I.Pottash, A.L.C. & Gold, M.S. (1981a) Relationship of thyrotropin-releasing hormone test and dexamethasone suppression test abnormalities in unipolar depression. Psychiatr. Res. 4, 49–53CrossRefGoogle Scholar
Extein, I., Pottash, A.L.C. & Gold, M.S. (1981b) The thyrotropin-releasing hormone test in the diagnosis of unipolar depression. Psychiatr. Res. 5, 311–317CrossRefGoogle Scholar
Feinberg, M. & Carroll, B.J. (1984) Biological “markers” for endogenous depression. Effect of age, severity of illness, weight loss and polarity. Arch. Gen. Psychiatry 41, 1080–1085CrossRefGoogle ScholarPubMed
Gold, M.S.Pottash, A.L.C.Davies, R.K.Ryan, N.Sweeney, D.R. & Martin, D.M. (1979) Distinguishing unipolar and bipolar depression by thyrotropin release test. Lancet 25, 411–412CrossRefGoogle Scholar
Gold, M.S.Pottash, A.L.C.Ryan, N.Sweeney, D.R.Davies, R.K. & Martin, D.M. (1980) TRH-induced TSH response in unipolar, bipolar and secondary depressions: possible utility in clinical assessment and differential diagnosis. Psychoneuroendocrinology 5, 147–155CrossRefGoogle ScholarPubMed
Haigler, E.D.Pittman, J.A.Hershman, J.M. & Bauch, C.M. (1971) Direct evaluation of pituitary thyrotropin reserve utilizing synthetic thyrotropin releasing hormone. J. Clin. Endocrinol. Metab. 33, 573–581CrossRefGoogle Scholar
Hasen, J.Boczko, M.Donovan, R. & Cianini, M. (1981) Blunted TSH response to TRH in patients with central nervous discase. Am. J. Med. Sci. 281, 130–134CrossRefGoogle Scholar
Kirkegaard, C.Bjørum, N.Cohn, D. & Lauridsen, U.B. (1978) TRH stimulation test in manicdepressive disease. Arch. Gen. Psychiatry 35, 1017–1023CrossRefGoogle Scholar
Kirkegaard, C. & Carroll, B.J. (1980) Dissociation of TSH and adrenocortical disturbances in endogenous depression. Psychiatr. Res. 3, 253–264CrossRefGoogle ScholarPubMed
Kirkegaard, C.Eskildsen, P.C. & Bjorum, N. (1981) Parallel changes of the responses of thyrotropin, growth hormone and prolactin to thyrotropin releasing hormone in endogenous depression. Psychoneuroendocrinology 6, 253–259CrossRefGoogle ScholarPubMed
Kirstein, L.Gold, M.S.Pottash, A.L.C. & Extein, I. (1981) Thyrotropin-releasing hormone test and male unipolar depression. Biol. Psychiatry 819–824Google ScholarPubMed
Kjellman, B.F.Ljunggren, J.G.Beck-Friis, J. & Wetterberg, L. (1985) Effect of TRH on TSH and prolactin levels in affective disorders. Psychiatr. Res. 14, 353–363CrossRefGoogle ScholarPubMed
Kupfer, D.J.Jarrett, D.B. & Franck, E. (1984) Relationship among selected neuroendocrine and sleep measures in patients with recurrent depression. Biol. Psychiatry 19, 1525–1536Google ScholarPubMed
Linkowski, P.Brauman, H. & Mendlewicz, J. (1981) Thyrotrophin-releasing hormone in unipolar and bipolar affective illness. J. Affect. Dis. 3, 9–16CrossRefGoogle ScholarPubMed
Loosen, P.T. & Prange, A.J. (1980a) Thyrotropin releasing hormone (TRH): a useful tool for psychoneuroendocrine investigation. Psychoneuroendocrinology 5, 63–80CrossRefGoogle Scholar
Loosen, P.T. & Prange, A.J. (1982) Serum thyrotropin response to thyrotropin-releasing hormone in psychiatric patients: a review. Am. J. Psychiatry 139, 405–416Google ScholarPubMed
Maes, M.De Ruyter, M.Hobin, P. & Suy, E. (1986) The dexamethasone suppression test, the Hamilton Depression Rating Scale and the DSM-III depression categories. J. Affect. Dis. 10, 207–214CrossRefGoogle ScholarPubMed
Macs, M.De Ruyter, M. & Suy, E. (1989) Use of the dexamethasone suppression test in an in-patient setting : a replication and new findings. Psychoneuroendocrinology (in press)Google Scholar
Marchesi, C.Chiodera, P.DeRisio, C.Dassó, L.Govi, A.M.De Ferri, A.Piagneri, B.Minelli, R.Bianconi, L.Gnudi, A. & Coiro, V. (1988) Dopaminergic control of TSH secretion in endogenous depression. Psychiatr. Res. 25, 262–287CrossRefGoogle ScholarPubMed
Naber, D.Steinbock, H. & Greil, W. (1980) Effects of short and longterm neuroleptic treatment on thyroid function. Prog. Neuro-Psychopharmacology 4, 199–206CrossRefGoogle Scholar
Papakostas, Y.Fink, M.Lee, .LIrwin, P. & Johnson, L. (1981) Neuroendocrine measures in psychiatric patients: course and outcome with ECT. Psychiatr. Res. 4, 55–64CrossRefGoogle ScholarPubMed
Prange, A.J.Lara, P.P.Wilson, I.C.Alltop, L.B. & Breese, G.R. (1972) Effects of thyrotropin-releasing hormone in depression. Lancet 11, 999–1002CrossRefGoogle Scholar
Prange, A.J. JrLoosen, P.T.Wilson, I.C.Meltzer, H.Y. & Fang, V.S. (1979) Behavioral and endocrine responses of schizophrenie patients to TRH (protirelin). Arch. Gen. Psychiatry 36, 1086–1093CrossRefGoogle Scholar
Rubin, R.T.Poland, R.E.Blodgett, A.L.N.Winston, R.A.Forster, B. & Hart, P.J. (1981) Endocrine responses to perturbation tests in primary endogenous depression: preliminary findings. In: The 3rd World Congress on Biological Psychiatry. Elsevier — North Holland, AmsterdamGoogle Scholar
Rush, A.J.Schlesser, M.A.Roffwarg, H.P.Giles, D.E.Orsulak, P.J. & Fairchild, C. (1983) Relationships among the TRH, REM latency, and dexamethasone suppression tests: preliminary findings. J. Clin. Psychiatry 44, 23–30Google ScholarPubMed
Scanlon, M.F.Weightman, D.R.Shale, D.J.Mora, B.Heath, M.Snow, M.H.Lewis, M. & Hall, R. (1979) Dopamine is a physiological regulator of thyrotropin (TSH) secretion in normal man. Clin. Endocrinol. 10, 7–15CrossRefGoogle ScholarPubMed
Snyder, P.J. & Utiger, R.D. (1972) Response to thyrotropine-releasing hormone (TRH) in normal man. J. Clin. Endocrinol. Metab. 34, 380–385CrossRefGoogle Scholar
Spitznagel, E.L. & Helzer, J.E. (1985) A proposed solution to the base rate problem in the Kappa statistic. Arch. Gen. Psychiatry 42, 725–729CrossRefGoogle ScholarPubMed
Sternbach, H.Gerner, R.H. & Gwirtsman, H.E. (1982) The thyrotropin-releasing hormone stimulation test: a review. J. Clin. Psychiatry 43, 4–6Google ScholarPubMed
Sternbach, H.A.Gold, M.S.Pottash, A.L.C. & Extein, I. (1983) Thyroid failure and protirelin (thyrotropin-releasing hormone) test abnormalities in depressed outpatients. J. Am. Med. Assoc. 249, 1618–1620CrossRefGoogle ScholarPubMed
Takahashi, S.Kondo, H.Yoshimura, M. & Ochi, Y. (1974) Thyrotropin response to TRH in depressive illness: relation to clinical subtypes and prolonged duration of depressive episodes. Folia Psychiatr. Neurol. Jpn 28, 355–365Google Scholar
Targum, S.D.Sullivan, A.C. & Byrnes, S.M. (1982a) Neuroendocrine interrelationships in major depressive disorders. Am. J. Psychiatry 139, 282–287Google Scholar
Targum, S.D.Sullivan, A.C. & Byrnes, S.M. (1982b) The TRH stimulation test in subtypes of unipolar depression. J. Affect. Dis. 4, 29–34CrossRefGoogle Scholar
Williams, J.B.W. & Spitzer, R.L. (1982) Research diagnostic criteria and DSM-III: an annotated comparison. Arch. Gen. Psychiatry 39, 1283–1289CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.