Disfunción tiroidea y trastornos del ánimo: revisión del estado del arte / Thyroid dysfunction and mood disorders: review of the state of the art

La relación entre función tiroidea y trastornos del ánimo se ha observado desde hace más de 50 años. Las hormonas tiroideas, actúan en el cerebro modulando génicamente proteínas asociadas a la fisiopatología de los trastornos del ánimo y potenciando los sistemas de neurotransmisión serotoninérgica y noradrenérgica. En el tratamiento de un episodio depresivo, la normalización de hormonas tiroideas es fundamental, y debe realizarse en todo paciente con sintomatología anímica, especialmente en aquellos con respuestas insuficientes a tratamiento, que requieren niveles de hormonas más estrictos que lo recomendado para población general. En pacientes eutiroideos, la potenciación con triyodotironina ha sido probada, pero también se ha utilizado T4 en altas dosis en casos resistentes, en que se postula que pudiese existir un estado de resistencia a hormonas tiroideas, no reflejado en los niveles hormonales periféricos evaluados rutinariamente. Las enzimas deiodasas, el receptor de hormona tiroidea, y el transportador de hormona tiroidea en la barrera hematoencefálica son blancos a investigar. Los objetivos de la presente revisión son ofrecer orientaciones respecto del uso de hormonas tiroideas en pacientes con trastornos del ánimo, una puesta al día sobre la relación entre hormonas tiroídeas y sistema nervioso central, y las interacciones entre psicofármacos y función tiroidea.

The relationship between thyroid function and mood disorders has been observed for more than 50 years. Thyroid hormones act in the brain genetically modulating proteins associated with the pathophysiology of mood disorders and potentiating the serotonergic and noradrenergic neurotransmission systems. In the treatment of a depressive episode, the normalization of thyroid hormones is essential, and should be performed in all patients with mood symptoms, especially in those with insufficient responses to treatment, which require more stringent hormone levels than recommended for the general population. In euthyroid patients, potentiation with triiodothyronine has been proven, but T4 has also been used in high doses in resistant cases, in which it is postulated that there might be a state of resistance to thyroid hormones, not reflected in the peripheral hormonal levels evaluated routinely. The enzymes deiodasas, the thyroid hormone receptor, and the thyroid hormone transporter in the blood brain barrier are white to investigate. The objectives of this review are to provide guidance regarding the use of thyroid hormones in patients with mood disorders, an update on the relationship between thyroid hormones and central nervous system, and the interactions between psychoactive drugs and thyroid function.

Depressive symptoms are associated with higher morning plasma cortisol in primary care subjects.

BACKGROUND: Cortisol dysregulation has a potential role in depression. AIM AND METHODS: We evaluated depressive symptoms using the Hamilton Rating Scale for Depression in 48 primary care subjects without history of previous or current depression and its association with cortisol dysregulation (morning plasma cortisol, 24-hour urinary free cortisol and cortisol metabolites). Presence of metabolic syndrome and inflammatory parameters were also assessed. RESULTS: Hamilton Rating Scale for Depression correlated significantly with morning cortisol, but not with urinary free cortisol or metabolites. A significant increase in morning cortisol by Hamilton groups (asymptomatic ≤8; mild to moderate: 9-18; moderate to severe: ≥19) was observed even when adjusted by age/gender. We observed no association of depressive symptoms with metabolic or inflammatory parameters. CONCLUSION: Depressive symptoms in primary care subjects not consulting for their mood are associated with higher morning plasma cortisol, but not urinary cortisol or its metabolites. These observations suggest that systemic hypercortisolism and related metabolic disorders are not observed in mild/initial states of depressive disorders.

[Geriatric vs. non-geriatric psychiatric hospitalization to the psychiatric services of a general hospital in Chile]. / Internación psiquiátrica geriátrica vs. no geriátrica en un servicio de psiquiatría de un Hospital General en Chile.

INTRODUCTION: It is estimated that Chilean geriatric population (=65 years) will hit 16% in the year 2030. Psychiatric longer stays have been described for those equal 65 years vs. less than 65 years. We aim to describe the characteristics associated with lengths of stay in our psychiatric unit. MATERIAL AND METHODS: Retrospective review of 3112 admissions between July 2001 and June 2010 to the general psychiatric service of the Pontific Catholic University of Chile. RESULTS: 5.1% (n=132) of the sample was geriatric patients. The average length of stay for this group was 12.4 days (p=0.41). Both the geriatric and non-geriatric population presented a high prevalence of affective disorders (63.7% and 55.1%, respectively). In the geriatric group, there was a higher presence of bipolar disorder (27.3 vs. 19.5%; p less than 0.05) and dementia (16.7% vs. 0.5%). In contrast, for = 65 years, there was significantly less prevalence of adaptive and anxiety disorders (3% vs. 13%; p less than 0.01). There was just one case of personality disorder and no cases of eating disorders in the geriatric group. There were no differences in the lengths of stay according to diagnosis. CONCLUSIONS: We did not find longer stay times, in general or associated with specific diagnoses, in geriatric patients versus non-geriatric patients.