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Depressive Symptoms and Major Depressive Disorder in Patients Affected by Subclinical Hypothyroidism: A Cross-sectional Study

Demartini, Benedetta MD*; Ranieri, Rebecca MD*; Masu, Annamaria MD; Selle, Valerio MD*; Scarone, Silvio MD*; Gambini, Orsola MD*

The Journal of Nervous and Mental Disease: August 2014 - Volume 202 - Issue 8 - p 603–607
doi: 10.1097/NMD.0000000000000168
Original Articles

The relationship between subclinical hypothyroidism and depression is still controversial. Our objective was to compare the prevalence of depressive symptoms and major depressive disorder in a population of patients affected by subclinical hypothyroidism and a control group without thyroid disease. The authors enrolled 123 consecutive outpatients affected by subclinical hypothyroidism undergoing follow-up at the endocrinology department of San Paolo Hospital in Milan and 123 controls without thyroid disease under the charge of general physicians.

All patients and controls underwent an evaluation by means of a psychiatric interview; Hamilton Rating Scale for Depression (HAM-D); Montgomery-Asberg Depression Rating Scale (MADRS); and serum thyroid stimulating hormone, free T4, and free T3 levels. Patients were also screened for thyroid peroxidase antibodies and thyroglobulin antibodies. Patients affected by subclinical hypothyroidism had a prevalence of depressive symptoms of 63.4% at HAM-D and 64.2% at MADRS; 22 patients (17.9%) had a diagnosis of depressive episode (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria). The control group had a prevalence of depressive symptoms of 27.6% at HAM-D and 29.3% at MADRS, and only seven controls had a diagnosis of depressive episode. The prevalence of depressive symptoms between these two groups was statistically different. This study underlines a strong association between subclinical hypothyroidism and depressive symptoms, which could have some important diagnostic and therapeutic implications in the clinical practice.

Departments of *Psychiatry, and †Internal Medicine, San Paolo Hospital and University of Milan, Milan, Italy.

Send reprint requests to Benedetta Demartini, MD, Department of Psychiatry, San Paolo Hospital, VA di Rudinì 8, 20142 Milan, Italy. E-mail:

© 2014 by Lippincott Williams & Wilkins