Association between postpartum thyroid dysfunction and thyroid antibodies and depression.

OBJECTIVE: To define the relation between mood and autoimmune thyroid dysfunction during the eight months after delivery. DESIGN: Double blind comparison of the psychiatric status of women positive and negative for thyroid antibodies. Clinical examination and blood sampling for free triiodothyronine and thyroxine, thyroid stimulating hormone, and thyroid antibody concentrations at four weekly intervals. Psychiatric assessment at six, eight, 12, 20, and 28 weeks post partum. SETTING: Outpatient department of district hospital. PATIENTS: 145 antibody positive women and 229 antibody negative women delivering between August 1987 and December 1989. MAIN OUTCOME MEASURES: Thyroid status. Number of cases of mental ill health by the general health questionnaire, research diagnostic criteria, Hamilton 17 item depression scale, hospital anxiety and depression scale, and Edinburgh postnatal depression scale. RESULTS: Six weeks after delivery the general health questionnaire showed 62 (43%) antibody positive women and 65 (28%) antibody negative women had mental ill health (chi 2 = 8.18, p less than 0.005). Follow up of 110 antibody positive and 132 antibody negative women showed significantly greater depression by research diagnostic criteria in antibody positive women (47%) than antibody negative women (32%) regardless of thyroid dysfunction. Antibody positive women showed higher mean scores for depression on the Hamilton (6.01 v 3.89, p = 0.0002), Edinburgh (7.45 v 5.92, p = 0.031), and hospital depression scales (4.95 v 3.79, p = 0.003). CONCLUSION: Depressive symptoms are associated with positive thyroid antibody status in the postpartum period.

The effect of benzodiazepine withdrawal on the dexamethasone suppression test.

Recent studies of the dexamethasone suppression test (DST) suggest lack of specificity for the diagnosis of melancholia. An earlier study showed that high doses of benzodiazepines lead to DST normalisation in depressed patients. This present study examines the effect of benzodiazepine withdrawal on the DST in a middle aged, non-depressed group. Forty-eight volunteers from a double blind placebo-controlled trial of triazolam 0.5 mg and lormetazepam 2 mg all suppressed normally when given the DST on the sixth day of withdrawal following 25 days of drug.

An NMR study of cerebral oedema and its biological correlates during withdrawal from alcohol.

Five chronic alcoholic patients admitted for detoxification were studied. During the first 24-48 hr of abstinence raised levels of cerebral water (as measured by NMR), vasopressin, renin and supine aldosterone were recorded. Initial vasopressin concentration was correlated (r = 0.88, P less than 0.05) with alcohol consumption in the week prior to admission and was over three times higher in the patients measured after 24-48 hr as compared to less than 24 hr. After one week only supine aldosterone was still raised (P less than 0.05). The results suggest that cerebral oedema occurs during the early stages of abstinence. The role of these changes in the aetiology of withdrawal symptoms, delirium tremens and brain damage remains to be elucidated.