Depressive relapse during lithium treatment associated with increased serum thyroid-stimulating hormone: results from two placebo-controlled bipolar I maintenance studies

Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 02/2009; 120(1):10-3. DOI: 10.1111/j.1600-0447.2008.01343.x
Source: PubMed


To assess the relationship between depressive relapse and change in thyroid function in an exploratory post hoc analysis from a controlled maintenance evaluation of bipolar I disorder.
Mean thyroid-stimulating hormone (TSH) and outcome data were pooled from two 18-month, double-blind, placebo-controlled, maintenance studies of lamotrigine and lithium monotherapy. A post hoc analysis of 109 subjects (n = 55 lamotrigine, n = 32 lithium, n = 22 placebo) with serum TSH values at screening and either week 52 (+/-14 days) or study drop-out was conducted.
Lithium-treated subjects who required an intervention for a depressive episode had a significantly higher adjusted mean TSH level (4.4 microIU/ml) compared with lithium-treated subjects who did not require intervention for a depressive episode (2.4 microIU/ml).
Lithium-related changes in thyroid function are clinically relevant and should be carefully monitored in the maintenance phase of bipolar disorder to maximize mood stability and minimize the risk of subsyndromal or syndromal depressive relapse.

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    • "Additionally, Frye et al. [85] reported that a lower mean serum level of free T4 was associated with more affective episodes and greater severity of depression during the first year of lithium-treatment. More recently, a retrospective analysis has shown that lithium-treated subjects who required an intervention for a depressive episode had significantly increased mean TSH levels, in comparison to lithium-treated subjects who did not require any intervention for depression [113]. "
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