The intervention effects of fluoxetine hydrochloride on hypothalamic-pituitary-thyroid axis function deficiency in patients with poststrok depression / 中华行为医学与脑科学杂志

ABSTRACT

ObjectiveTo investigate the intervention effects of fluoxetine on hypothalamic-pituitary-thyroid (HPT) axis function changes in post-stroke depression (PSD) patients.MethodsMild to moderate stroke patients were enrolled and blood T3,T4,FT3,FT4 and TSH were measured at day 0,1,7,14,21 and 3 months.At day 7,thyroid hormone releasing hormone (TRH) stimulation test were performed.After evaluated with the anxiety scale screening using the HAMD scale assessment at day 21,the subjects were divided into simple stroke subgroup ( ＜8 points,25 cases) and PSD sub-group ( ≥ 8 points,18 cases),with 16 healthy age and sex matched individuals as control group.In the 2nd stage,TRH stimulation test were performed in PSD patients before and after 7 days of fluoxetine administration.ResultsCompared with control group,stroke patients presented lower FT3 (P ＜0.05 ) and higher serum TSH (P ＜ 0.05) at day 0,1,7,14.Furthermore,PSD patients presented lower FT3,TSH levels and higher FT4 levels than simple stroke patients did(P＜0.05).At day 21 and month 3,T3,T4,FT3,FT4 and TSH levels in stroke patients were not different from those in control group(P ＞ 0.05).TRH test showed that the responses in PSD patients were lower than those in simple stroke patients( (2.65 ±0.42)μIU/ml vs (5.31 ±0.68 ) μIU/ml,P ＜ 0.05 ).Correlation analysis showed HAMD scores correlated with TSH level changes and TSH0 ～30 in PSD subgroup closely( r=0.35,0.25,P＜0.01 ).In the 2nd stage,TRH test showed that PSD patients who took fluoxetine presented a lower TSH level change than PSD patients who did not( (4.61 ± 2.02) μIU/ml vs (7.05 ± 2.12) μIU/ml,P ＜ 0.05 ).ConclusionPSD patients present a long and severe HPT axis function inhibition,which may due to TRH deficiency,and fluoxetine may improve this abnormality.