Thyroid dysfunction in first-episode drug-naïve major depressive disorder patients with or without psychotic symptoms

Abstract Background It is a common of comorbid psychotic symptoms in patients with major depressive disorder (MDD). However, there are few studies on the thyroid function of psychotic depression (PD) in first-episode drug naïve (FEDN) MDD patients. This study was to examine the difference in thyroid function between PD and NPD of first-episode drug-naïve (FEDN) major depression (MDD) and explore the related risk factors for PD in a large sample size of patients in a Chinese population. Methods We recruited 1718 outpatients diagnosed with FEDN MDD. The thyroid function-related parameters, including thyroid-stimulating hormone (TSH), free thyroxin (FT4, FT3)7, thyroid peroxidase antibodies (TPOAb), and anti-thyroglobulin (TGAb), socio-demographic and clinical data were collected. The Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), and the positive subscale of the Positive and Negative Syndrome Scale (PANSS) were administered to score patients’ anxiety, depression, and psychotic symptoms. Results The elevated TSH, TPOAb, and TGAb serum accounted for 79.5%, 28.7%, and 35.9% of PD patients, respectively. Compared to NPD patients, PD patients had higher serum levels of TSH, TGAb, and TPOAb (all P < 0.001). Furthermore, logistic regression analysis demonstrated a strong association between the serum level of TSH and PD, with an odds ratio of 1.189. Conclusions Our findings suggest that elevated TSH levels may increase the risk of PD and highlight the importance of thyroid screening tests for the accurate diagnosis and effective treatment of PD.