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Relationship between psychotropic drugs and thyroid function: a review

M F Sauvage1, P Marquet, A Rousseau

  • 1Department of Pharmacology and Toxicology, Faculty of Pharmacy, University Hospital, Limoges, France.

Toxicology and Applied Pharmacology
|May 8, 1998
PubMed
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Psychoactive drugs like tricyclic antidepressants and phenothiazines can harm thyroid function by interfering with hormone production and iodine uptake. These drug-induced thyroid effects may influence treatment outcomes for affective disorders.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Neuroscience

Background:

  • Psychoactive medications, including tricyclic antidepressants and phenothiazine antipsychotics, are frequently prescribed for psychiatric conditions.
  • These drugs have been observed to cause iatrogenic (medication-induced) effects on thyroid function.
  • The thyroid gland plays a crucial role in regulating mood and cognitive processes, and its function can be influenced by psychiatric medications.

Purpose of the Study:

  • To review the potential mechanisms by which tricyclic antidepressants and phenothiazines impact thyroid hormone biosynthesis and function.
  • To explore the clinical implications of these drug-induced thyroid effects on the management of affective disorders.
  • To highlight the serious consideration required for thyroid toxicity during long-term psychiatric treatment.

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Main Methods:

  • Literature review of studies investigating the effects of tricyclic antidepressants and phenothiazines on thyroid hormone synthesis, iodine metabolism, and thyroid autoimmunity.
  • Analysis of clinical observations linking thyroid status to antidepressant efficacy and recovery from depression.
  • Examination of proposed interactions between these drugs and the hypothalamic-pituitary-thyroid axis.

Main Results:

  • These drugs can interfere with iodine capture, thyroid peroxidase activity, and deiodinase activity, potentially decreasing thyroid hormone levels (T3 and T4).
  • Tricyclic antidepressants may disrupt the hypothalamic-pituitary-thyroid axis via neurotransmitter systems.
  • Phenothiazines have been linked to autoimmune hypothyroidism, evidenced by increased MHC antigen expression and antibody production.

Conclusions:

  • The mechanisms of drug-induced thyroid dysfunction are complex and involve multiple steps in hormone synthesis and regulation.
  • Thyroid status significantly influences the effectiveness of antidepressant treatment, and vice versa.
  • Long-term use of these psychoactive drugs necessitates careful monitoring for thyroid-related side effects due to their potential impact on treatment efficacy and patient health.